About 3 million U.S. residents have seropositive cytomegalovirus. Seropositive rates were higher among U.S. residents with fewer years of education. The study does not, however, exclude the possibility that the rates of seropositivity represent unrecognized or asymptomatic cytomegalovirus infections.
Cytomegalovirus infections can be divided into primary and secondary infection. Primary cytomegalovirus infections occur in healthy individuals. Primary infections are diagnosed by detecting CMV-specific IgM antibodies in the blood or detection of a replicating virus in cultures. CMV disease can occur in the kidney or heart, or in the blood. When it occurs in the blood, it is called CMV infections.\n\nSecondary CMV infection results from prior CMV infection in a host, often in a chronically low state. Immunosuppressed host can become latent at a later stage, such as those who have had organ transplants. When the immune system is compromised the virus is reactivated, causing the disease.
Cytomegalovirus infection is common in transplant patients and is caused by the body's ability to produce immune and nonimmune responses to infection. For example, some patients display an infection without other symptoms of disease, and some show acute symptoms only once an infection has occurred. The exact cause of the infections is unknown. However, herpes viruses, such as CMV, may play a role in initiating the infection. Diagnosis of cytomegalovirus infection requires laboratory test (i.e., culture or antigen or DNA detection). Treatment for infection begins with the identification of the patient, and is followed by the start of antiviral therapy.
There are many treatments for cytomegalovirus infections. Immunosuppression can be associated with cytomegalovirus reactivation. Prophylaxis or treatment of cytomegalovirus infections are based on the type of infection and how serious the illness may be. Treatment for cytomegalovirus infection may include antivirals such as ganciclovir, foscarnet, or valganciclovir, which may be used by mouth, by injection, or in pill form. Prophylactic treatments may include high dose immunoglobulin (IV or subcutaneous injections), plasma exchange, leukoreduction or filtration, hyperimmune serum, or azithromycin.
Although many treatments have improved in the last decade, the use of antiviral medication to treat cytomegalovirus infections to prevent symptomatic disease and death has not evolved in parallel. More advanced knowledge of the pathogenesis of cytomegalovirus and of the host-pathogen interaction will likely lead to improved treatments. If successful, it might also serve as a model for other, as yet unknown human pathogens for which effective antiviral treatment has yet to be discovered.
Patients in our study with HCMV viral load above the threshold of clinical suspicion of HCMV-related complications. Moreover, they had an increased requirement of corticosteroid and immunosuppressive agents and were more likely to die from the infection. We suggest considering a clinical trial in this group.
There is weak evidence that pentamer (med)/gb(med)/adjuvant vaccine could increase survival in the setting of early HIV infection and that in this setting it might be effective even without prophylactic antiviral therapy. Adjuvant vaccination is safe and effective in HIV-infected and HIV-uninfected patients and can be offered to all patients at an early stage of disease to potentially prevent progression of disease.
CMV infections occur in 10-25% of children with hematological malignancies in the UK. A possible clue to the trigger could be an increased rate of immunosuppression as a consequence of HIV treatment. Further work would be beneficial to elucidate the risk and protective factors for CMV infections among patients with HIV-associated acute lymphoid leukaemia.
The use of recombinant adenovirus based pentamer vaccines [Gb(med)/Gb(null),Ad53] had a positive effect on survival and the control of tumor growth. Additionally, the pentamer vaccines showed an effect on immunity. These vaccines are in an advanced stage of development.
There was extensive data suggesting a correlation between HCMV reactivation and development of cognitive impairment. There is still an ongoing debate if HCMV affects development of Alzheimer's disease. Research on this topic is ongoing and further efforts should be made to establish more conclusive findings in the future.
CMV infections can lead to the development of organ-specific problems in immunocompromised patients and they are more lethal than HIV infections. CMV-infected liver cirrhosis patients and kidney grafts recipients have lower survival rates compared with other groups. They are more likely to have complications and require a new transplant operation. CMV-infected patients have a high risk-adjusted death rate and they do not achieve the same long-term survival. If this is the result of CMV or HIV hepatosuppression, this risk can be increased more.