Investigation of CMV disease in immunocompromised patients

Abstract

Cytomegalovirus (CMV) is a recognised cause of morbidity and mortality in immunocompromised individuals. This review will concentrate on recent advances in the understanding of the complex interplay between the host and parasite and the pathological consequences of perturbation of the host immune system. The classic view of CMV as a slowly replicating virus is challenged by recent in vivo findings suggesting that active replication occurs dynamically in the human host, with a doubling time of approximately one day. In addition, CMV load plays a major role in viral pathogenesis, such that increased CMV replication is a significant risk factor for disease in all immunocompromised groups studied to date. These studies focus attention on understanding the virological and immunological determinants of enhanced viral replication and its pathological consequences.

Figure 1 Distribution of cytomegalovirus (CMV) load in cell types present in the blood (granulocytes/neutrophils, monocytes, B cells, and T cells) during an active CMV infection of a renal transplant recipient. Cell subsets were purified using Dynabeads coated with the appropriate antibody and a combination of positive and negative selection according to the recommendations of the manufacturer.

Figure 2 Kaplan-Meier survival curves showing the influence of baseline cytomegalovirus (CMV) load in the blood on (A) time to disease and (B) death in a cohort of human immunodeficiency virus (HIV) infected individuals enrolled in ACTG204.⁵⁸