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The presence of cytomegalovirus
(CMV) in blood and semen is associated with higher levels of HIV DNA in blood,
investigators from the United States report in the online edition of Journal of
Infectious Diseases. The study involved gay men recently infected with HIV. The
authors believe that CMV replication may increase the reservoir of cells
latently infected with HIV.
“This study demonstrated that
presence of CMV in PBMC [peripheral blood mononuclear cells] and in seminal
plasma of HIV infected ART-naïve MSM was associated with higher levels of
proviral HIV DNA,” write the authors. “It also found that simultaneous
detectable CMV in semen and PBMC was associated with the highest levels of HIV
DNA in PBMC.”
Over 75% of HIV-positive gay men
have at least one herpes virus actively replicating in their semen and the most
common is CMV. Co-infection with CMV has been associated with accelerated HIV
disease progression and increased immune activation. Investigators from San
Diego hypothesised that it could also be an important factor in determining the
size of the reservoir of cells with latent HIV infection.
They therefore designed an
observation study involving 113 gay men recently infected with HIV. None were
taking antiretroviral therapy. Paired semen and blood samples were provided for
analysis. CMV DNA was quantified, as was proviral HIV DNA in PBMC, HIV viral
load and CD4 cell count.
The participants had been infected
with HIV for a median of 70 days at baseline. Median CD4 cell count at this
time was 523 cells/mm3 and median blood plasma viral load was 50,000 copies/ml.
Approximately 46% of participants provided semen samples positive for CMV
(median peak viral load 4.52 log10 DNA copies/ml).
Just over half the cohort (52%)
provided paired longitudinal samples for analysis (median follow-up, 67 days).
Approximately a fifth had intermittent CMV shedding in semen and 10% had
intermittently detectable CMV DNA in PBMC. HIV DNA was detected in 91% of PBMC
samples.
Analysis of the entire cohort showed
that higher levels of HIV in DNA were associated with longer duration of HIV
infection, and the presence of CMV in PBMC.
However, blood plasma viral load and
CD4 cell count were not associated with HIV DNA levels. The investigators were
surprised by this finding and performed two sub-analyses. The first excluded
participants with low-level HIV DNA. This revealed a positive association
between HIV viral load and HIV DNA (p = 0.01). The second excluded participants
with an estimated duration of infection of up to 120 days. This showed no
association between HIV viral load and HIV DNA. Nor was the presence of a
sexually transmitted infection at baseline associated with HIV DNA levels.
In multivariate analysis, the
association between CMV in PBMC and higher levels of HIV DNA in PBMC was
significant (p = 0.05).
Participants with detectable CMV in
both semen and PBMC were more likely to have higher HIV DNA levels in PBMC than
individuals with undetectable CMV in both semen and PBMC (p = 0.02).
“This study provides important
insights in regard of one possible mechanism contributing to the establishment
of the viral reservoir during early HIV infection,” the investigators conclude.
“Future studies should determine if persistent CMV replication can be targeted
as a strategy to reduce the size of the latent HIV reservoir.”
The Friends of AIDS Foundation is
dedicated to enhancing the quality of life for HIV positive individuals and
empowering people to make healthy choices to prevent the spread of the HIV
virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.
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