THE INFLUENCE OF CYTOMEGALOVIRUS ON THE NATURAL-HISTORY OF HIV-INFECTION - EVIDENCE OF RAPID COURSE OF HIV-INFECTION IN HIV-POSITIVE PATIENTS INFECTED WITH CYTOMEGALOVIRUS

We studied a cohort of 299 HIV-positive individuals with known date of seroconversion to evaluate the role of Cytomegalovirus (CMV) in the n atural history of HIV. The study population consisted of 236 initially CMV-positive patients, 55 CMV-negative subjects and 8 CMV seroconvert ers. The study endpoints were the decline to CD4 + < 200 x 10(6) cells /l, AIDS, and death. The cumulative risk of CMV disease and the surviv al after CMV disease were also investigated. At intake, there was no i nter-group difference in sex, age, risk behaviours, history of hair) l eucoplakia or herpes tester and antiretroviral treatment. During the f ollow-up, 108 patients fell below 200 CD4+ x 10(6) cells/l, 72 develop ed AIDS and 63 died. Twenty-one subjects had CMV disease. The cumulati ve incidence of CMV disease in the cohort was 18.9% and 23.3% within 8 and 9 years for the initially CMV-positive patients and 33.3% and 66. 7% for the CMV seroconverters (log-rank test: p = 0.101). The median s urvival after CMV disease was 153 days (range: 28-855, interquartile r ange: 261), with a cumulative survival of 45.1%, 16.9% and 4.3% within 6, 12 and 18 months, respectively. On Cox's regression, the acute MV seroconversion was an independent predictor of each endpoint, history of hairy leucoplakia or herpes tester being associated only with CD4cell decline. Baseline CMV seropositivity was related to short surviva l (p = 0.037) and 2 x 2 inter-group comparison showed that older indiv iduals with sexually acquired HIV who seroconverted to CMV had higher rates of progression to the study endpoints. Our data suggest that CMV infection influences the natural history of HIV disease and that CMV disease strongly affects the survival of the HIV-positive patients.