AEGiS-13IAC: Cytomegalovirus seroconversion during HIV-1 infection.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Cytomegalovirus seroconversion during HIV-1 infection.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. TuOrC372)

Robain M, Boufassa F, Persoz A, Hubert J-B, Meyer L
M. Robain, Hopital Bicotre INSERM, 78 rue du general Leclerc, Le Kremlin Bicotre, 94276, France, Tel.: +33 1 45 21 23 65, Fax: +33 1 45 21 20 75, E-mail: robain@vjf.inserm.fr

BACKGROUND: The influence of Cytomegalovirus seroconversion as a co-factor of HIV-1 disease progression remains controversial. Moreover, few cohorts of HIV-infected patients have monitored CMV serology over a long follow-up. We studied the role of a CMV seroconversion occurring after HIV seroconversion on progression to AIDS, before HAART era.

METHODS: Between 1988 and 1996, 1733 HIV-1 infected subjects have been enrolled in the French SEROCO/HEMOCO cohorts and followed every 6 months. Serological testing for CMV infection was performed at enrollment and then every 6 months in the 290 CMV seronegative subjects. All subjects were censored on January 1st 1996 before the widespread use of HAART. CMV disease was excluded from the AIDS definition. Using a Cox model with CMV seroconversion as a time dependent variable, the relative risk (RR) of progression to clinical AIDS was adjusted for age, exposure group, PPC prophylaxis and progression to CD4+ cell counts less than 200/mL.

RESULTS: The incidence of CMV seroconversion during follow-up (n = 61) was 4.4 /100 person-year (2.9 in hemophiliacs and patients HIV infected through blood transfusion, 6.5 in sexual exposure group and 4.6 in injecting drug users). Age and CD4+ cell counts at baseline were similar in CMV negative and CMV seroconverter subjects. Adjusted RR for progression to CD4 > 200 was 0.9 ('0.4 - 1.9'; p = 0.74). Conversely, aRR for progression to AIDS was 2.1 ('1.1 - 3.9'; p = 0.02). Median CD4 cell counts at the time of AIDS onset was 102/mL in CMV seroconverters and 26 in CMV negative subjects (p = 0.14).

CONCLUSION: These results suggest that CMV seroconversion during HIV-1 disease accelerates progression to clinical AIDS.

Keywords: AEGIS, HIV Infections, Cytomegalovirus, Acquired Immunodeficiency Syndrome, CD4 Lymphocyte Count, Cytomegalovirus Infections, HIV-1, HIV Seropositivity, Incidence, Hemophilia A, Proportional Hazards Models, Greece, Human
000709
TuOrC372