CMV neurological disease in people living with HIV is associated with severe immunosuppression, frequent concomitant opportunistic infections, prolonged hospitalization, and high mortality.
Data on cytomegalovirus (CMV) neurological disease in people living with HIV (PLHIV) are scarce in Brazil. This study aimed to describe the main clinical, laboratory, and outcome characteristics of PLHIV with CMV neurological disease. Observational case series conducted in a tertiary hospital in São Paulo over 28 months. Inclusion criteria: (i) HIV-1 infection; (ii) presence of encephalitis, ventriculoencephalitis, and/or myeloradiculopathy; and (iii) detection of CMV DNA in cerebrospinal fluid by PCR. Descriptive statistics were performed. Twenty-six patients were included, 22 (85%) male, median age (IQR) 40 (35–47) years. Fourteen (54%) had been diagnosed with HIV-1 infection ≤ 6 months prior, and 11 (42%) were on ART at admission. Median (IQR) CD4+ count and HIV-1 viral load were 39 (19–53) cells/µL and 712,417 (165,528–2,032,500) copies/mL, respectively. Twenty (77%) patients presented at least one concomitant opportunistic infection (OI), and 13 (50%) had two or more, most commonly cerebral toxoplasmosis (50%, n =13). Encephalitis was the predominant presentation (77%, n = 20), followed by myeloradiculopathy (23%, n = 6) and ventriculoencephalitis (19%, n = 5). Thirteen (50%) had extra-neurological CMV disease, most commonly gastrointestinal involvement (27%, n = 7). Median (IQR) plasma CMV viral load (n = 20) was 65,382 (42,331–189,149) copies/mL. Median (IQR) time from admission to initiation of antiviral therapy (ganciclovir and/or foscarnet) and ART were 10 (3–20) and 14 (9–23) days, respectively. Median hospital stay was 53 (34–66) days. In-hospital and 90-day post-discharge mortality were 46% (n = 12) and 54% (n = 14), respectively. Patients with CMV neurological disease presented severe immunosuppression; encephalitis was the most frequent presentation, and concomitant OIs were common. Extra-neurological CMV disease was identified in 50% of cases, and plasma CMV viral load was markedly elevated. Hospitalization was prolonged, and mortality was high.
Silva et al. (Sun,) studied this question.