Treatment of cytomegalovirus remains a priority in order to improve the prognosis for people with HIV-1 infection

Results of a UK study in this week's issue of THE LANCET highlight how the treatment of cytomegalovirus infection remains a priority in order to improve the prognosis for people with HIV-1 infection, including people already receiving antiretroviral therapy.

The advent of highly active antiretroviral therapy (HAART) at the end of the 20th century dramatically improved treatment for people with HIV-1 infection. Before HAART, cytomegalovirus (CMV) was a major cause of opportunistic infection in HIV-infected patients and was associated with accelerated progression to AIDS and death.

Paul Griffiths from the Royal Free and University College Medical School, London, UK, and colleagues investigated whether CMV remains a significant risk factor for progression of HIV disease and death in the era of HAART. 374 people with HIV-1 infection were studied; their CMV status was assessed by polymerase chain reaction (PCR) and rates of new CMV disease, new AIDS-defining disorders, and death were calculated over a 3-year period. CMV-positive status was significantly associated with more than a doubling in progression time to a new AIDS-defining disorder, and with a fourfold shorter time to death.

Professor Griffiths comments: "The detection of cytomegalovirus in blood by PCR continues to identify patients with a poor prognosis, even in the era of HAART. Randomised controlled clinical trials of drugs active against cytomegalovirus are needed to investigate whether this virus is a marker or a determinant of HIV disease progression."

Cytomegalovirus, also often labeled CMV, is a type of Herpes virus also known (in humans) as human herpesvirus type 5, or HHV-5. It is in the betaherpesvirinae subfamily of Herpes. The name means "cell very big virus".

CMV especially attacks salivary glands and may also be devastating or even fatal to fetuses. CMV viruses are found in many mammal species, but generally are specific only to that species.