Differential Diagnosis of Cytomegalovirus Infection and Disease in HIV/AIDS Patients: A Six-Year Retrospective Analysis/HIV/AIDS Hastalarinda Sitomegalovirus Infeksiyonu ve Hastaliginin Ayirici Tanisi: Alti Yillik Retrospektif Bir Analiz

• Published in: KLIMIK dergisi Vol. 37; no. 2; p. 104
• Main Authors: Borcak, Deniz, Senoglu, Sevtap, Yesilbag, Zuhal, Ozdemir, Yusuf Emre, Canbolat-Unlu, Esra, Gedik, Habip, Kart-Yasar, Kadriye
• Format: Journal Article
• Language: English
• Published: DOC Design and Informatics Co. Ltd 01.06.2024
• Subjects: Antiviral agents; Cytomegalovirus infections; Diagnosis; DNA; Health aspects; Highly active antiretroviral therapy; HIV (Viruses); Infection; Mortality; T cells; Viral proteins
• ISSN: 1301-143X; 1309-1484
• DOI: 10.36519/kd.2024.4555

Objective: It is difficult to distinguish cytomegalovirus (CMV) infection and disease since CMV is a latent virus and can cause recurrent infections. Positive CMV tests may not necessarily be indicative of active disease. There is no clear threshold value for plasma CMV-DNA polymerase chain reaction (PCR) levels to distinguish disease from viral reactivation. In this study, we aimed to determine a numerical value to identify CMV-related clinical syndromes and to differentiate between CMV infection and disease in HIV/AIDS patients. Methods: HIV/AIDS patients aged [greater than or equal to] 18 years with a positive CMV viral load in plasma of any titer were included in the study. Sociodemographic, clinical, and laboratory data were extracted from patient files. Cytomegalovirus-related disease was defined as the isolation or detection of viral proteins or nucleic acid in a tissue sample or any body fluid in the presence of clinical signs related to the organ involved. CMV infection was diagnosed based on evidence of CMV replication without CMV symptoms or signs. A ROC curve was created to determine a cut-off value to distinguish CMV infection and disease. Results: Eighteen patients had CMV-related disease, and 18 had CMV infection. Clinical and laboratory parameters were compared between the two groups. The end organs' involvement was detected in the CMV disease group, and gastrointestinal involvement was the most common. The CMV-DNA PCR threshold level among patients with CMV disease and infection was determined as 3154 copies/mL. The risk of CMV disease increased with decreasing [CD4.sup.+] T lymphocytes count and increasing HIV viral load. Conclusion: Since CMV illness can have life-threatening effects, a precise and prompt diagnosis is essential. Antiviral therapy can reduce the morbidity and mortality of CMV infection. The CMV-DNA PCR threshold level determined in this study will guide clinicians in the early diagnosis of CMV disease. Keywords: CMV, HIV, polymerase chain reaction, antiretroviral therapy Amac: Tekrarlayan ve latent kalabilen bir infeksiyon etkeni olmasi nedeniyle sitomegalovirus (CMV) infeksiyonu ve hastaligini ayirt etmek guctur. Sitomegalovirus varligini arastiran testlerin pozitif olmasi her zaman aktif hastaligi gostermez. Hastaligi viral reaktivasyondan ayirt etmede, gercek zamanli kantitatif polimeraz zincir reaksiyonu (kPCR) yontemiyle gerceklestirilen plazma CMV-DNA olcumleri icin net bir esik deger yoktur. Bu calismada HIV/AIDS hastalarinda; CMV ile iliskili klinik sendromlari tanimlamak ve CMV infeksiyonu ile hastaligin ayrimini yapmak icin sayisal bir deger belirlenmesi hedeflendi. Yontemler: Plazmada pozitif CMV viral yuku olan, 18 yas ve uzeri HIV/AIDS hastalari calisma kapsamina alindi. Sosyodemografik, klinik ve laboratuvar verileri hasta dosyalarindan alindi. Sitomegalovirus hastaligi tanisi, diger etiyolojiler ekarte edildikten, tutulan organ ile ilgili klinik belirtiler varliginda herhangi bir vucut sivisinda viral nukleik asidin tespiti ile konulurken CMV infeksiyonu tanisi CMV ile ilgili semptom veya bulgular olmaksizin, plazmada CMV-DNA kPCR pozitifligi ile konuldu. Sitomegalovirus infeksiyonu ile hastaligini ayirt etmek icin ROC egrisi olusturularak, plazmada CMV-DNA kPCR esik degeri belirlendi. Bulgular: On sekiz hastada CMV ile iliskili hastalik ve 18 hastada CMV infeksiyonu oldugu belirlendi. Her iki grubun klinik ve laboratuvar parametreleri karsilastirildi. Sitomegalovirus hastaligi olan grupta hedef organ tutulumlari tespit edilmis olup en sik olarak gastrointestinal tutulum saptandi. Sitomegalovirus hastaligi ve infeksiyonu olan hastalarda CMV-DNA kPCR esik degeri 3154 kopya/ml olarak tespit edildi. [CD4.sup.+] T lenfosit sayisinin azalmasi ve HIV viral yukunun artmasiyla CMV hastaligi riskinin arttigi bulundu. Sonuc: Sitomegalovirus hastaligi hayati tehdit eden sonuclara yol acabilecegi icin dogru ve erken teshis son derece onemlidir. Antiviral tedavi ile CMV infeksiyonuna bagli morbidite ve mortalite onlenebilir. Bu calismada saptanmis olan CMV-DNA kPCR esik degeri hastaligin erken tanisinda klinisyenlere yol gosterici olacaktir. Anahtar Sozcukler: CMV, HIV, polimeraz zincir reaksiyonu, antiretroviral tedavi