Editor’s Choice: Restimulating Interest in Cytomegalovirus as a Cofactor for HIV Infection
Journal of Infectious Diseases January 15, 2015 211 (2) P.169-171
Vincent C. Emery
Cytomegalovirus (CMV) is a complex virus that continues to contribute to morbidity in a range of patients.
These include solid organ and stem cell transplant recipients, in whom the virus is associated with both direct effects, such as CMV hepatitis  and gastrointestinal disease, and indirect effects, including acute rejection, reduced long-term graft function, accelerated posttransplantation vascular disease, and, in some cases, death .
In addition, CMV remains an important cause of congenital disease, leading to a range of sequelae, including microcephaly, mental retardation, and sensorineural hearing loss .
In human immunodeficiency virus (HIV)–infected individuals, CMV was once one of the most feared pathogens because it led to sight-threatening retinitis in patients whose CD4+ T-cell counts dropped below 50 cells/µL, and despite anti-CMV therapy, recurrences of infection were frequent and often due to drug-resistant strains of CMV [4, 5].
Fortunately, in HIV-infected populations with access to effective antiretroviral therapy (ART), the incidence of CMV retinitis is now very rare, and CMV disease in HIV patients has become a distant memory for many physicians.
Given the strong association of CMV with inflammation  and a skewing of the T-cell immune response , it is noteworthy that in the early days of the HIV epidemic, CMV was suggested as a cofactor for HIV disease progression. A seminal article in this area was published in 1989 by Webster et al .
This study investigated 108 HIV type 1 (HIV-1)–infected hemophiliac men whose date of HIV seroconversion was accurately known; the men were then stratified according to their CMV immunoglobulin G (IgG) status. Individuals with prior CMV infection, …
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