{"id":217,"date":"2023-01-01T12:00:58","date_gmt":"2023-01-01T12:00:58","guid":{"rendered":"http:\/\/moomango.co.uk\/ttfa\/5-opportunistic-infections-ois-and-coinfections\/5-10-cmv"},"modified":"2023-01-25T13:33:25","modified_gmt":"2023-01-25T13:33:25","slug":"10-cmv-cytomegalovirus","status":"publish","type":"page","link":"https:\/\/i-base.info\/ttfa\/5-ois-and-coinfections\/10-cmv-cytomegalovirus\/","title":{"rendered":"5.10 CMV (cytomegalovirus)"},"content":{"rendered":"<h2 id=\"type\">Type of infection<\/h2>\n<p><strong>CMV (cytomegalovirus) is a very common viral infection that most people are not aware of<\/strong>.<\/p>\n<p>CMV is common and widespread. Over 50% of the general population, over 60% in intravenous drug users and over 90% in gay men are CMV-positive, In most cases CMV does not have symptoms or cause daily problems.<\/p>\n<p>CMV becomes a serious problem when the immune system is low. This mainly affects people living with HIV who have a very low CD4 count or who have an organ transplant.<\/p>\n<p>CMV becomes a threat when the CD4 count drops below 50 cells\/mm<sup>3<\/sup>. After HIV treatment (ART), a\u00a0CD4 count increase to above 50\u2013100 cells\/mm<sup>3<\/sup>\u00a0should stop firther damage from CMV.<\/p>\n<h2 id=\"main\">Main symptoms<\/h2>\n<p>CMV infection can affect many different organs.<\/p>\n<ul>\n<li><strong>Eyes (CMV retinitis).\u00a0<\/strong>This can cause progressive and permanent eye damage. Early symptoms include floaters, blind-spots, blurred or dark area of vision, flashing lights and vision loss.<\/li>\n<li><strong>Eyes.<\/strong>\u00a0Sometimes CMV affects <strong>peripheral vision<\/strong> without this being obvious. It is essential that everyone with a CD4 count under 50 has regular eye checks (every 1-3 months).<\/li>\n<li><strong>Throat.<\/strong>\u00a0Pain while swallowing, chest pain, and hiccups.<\/li>\n<li><strong>Gut, stomach, bowel, rectum.<\/strong>\u00a0Diarrhoea, bleeding, loss of appetite, weight loss, chest pain.<\/li>\n<li><strong>Lungs (often with PCP)<\/strong>. Chest pain.<\/li>\n<li><strong>Brain and the central nervous system (CMV encephalitis).<\/strong>\u00a0This is very serious. It can be fatal if CMV reaches the brain and the immune system is unable to control it.<\/li>\n<\/ul>\n<h2 id=\"diagnosis\">Diagnosis<\/h2>\n<p>CMV retinitis is diagnosed by eye examination.<\/p>\n<p>CMV in other organs is diagnosed by tests on a sample from the affected part of the body.<\/p>\n<h2 id=\"treat\">Treatment<\/h2>\n<ul>\n<li><strong>CMV retinitis.<\/strong>\u00a0Immediate treatment is essential, as damage to the eyes is permanent. Ganciclovir and foscarnet are preferred first-line treatment. Local treatment (ie just to the affected eye) can be given by a direct injection into the eye. This will not control CMV in other parts of the body.<\/li>\n<li><strong>Other organs. <\/strong>The same drugs are used to treat CMV in other organs.<\/li>\n<\/ul>\n<p>The three main treatments are <strong>ganciclovir, foscarnet<\/strong> and (rarely)\u00a0<strong>cidofovir<\/strong>. These drugs are usually given by slow IV delivery, twice a day, starting on the day of diagnosis. When treatment is needed for more than 1-2 weeks, a central line (Hickman line or PortaCath) is usually inserted into a deep vein.<\/p>\n<p>Some drugs are given as tablets, slow release implants or injection directly into the affected part of the body. <strong>Valganciclovir<\/strong> (proganciclovir) is a new tablet to replace the tablet form of ganciclovir. <strong>Cidofovir<\/strong> is given with a second tablet called <strong>probenecid<\/strong> to help prevent kidney damage but it is now rarely used because of this toxicity.<\/p>\n<p>ARV treatment that brings CD4 counts back over 50 cells\/mm<sup>3<\/sup> is the best medium- and long-term treatment.<\/p>\n<p>CMV treatment can be <strong>safely stopped<\/strong> once the\u00a0<strong>CD4 count is over 100 cells\/mm<sup>3<\/sup>\u00a0for several months \u2013 perhaps even over 50 cells\/mm<sup>3<\/sup><\/strong>. Otherwise, this difficult treatment is life-long.<\/p>\n<p>Starting HIV\u00a0treatment (ART), especially at very low CD4 counts, can make the immune system over-react. This can complicate CMV treatment and needs special management.<\/p>\n<p>This overreaction is\u00a0a form of <strong>IRIS<\/strong> (immune reconstitution inflammatory syndrome).<\/p>\n<h2 id=\"prevent\">Prophylaxis<\/h2>\n<p>There <strong>may be a role<\/strong> for prophylaxis with valganciclovir tablets in people with CD4 counts under 50 cells\/mm<sup>3<\/sup> who are not responding to HIV treatment. This has to be balanced against the side effects of the drugs and the risk of developing resistance.<\/p>\n<p>In general, prophylaxis against CMV is not recommended. It is much better to start or change HIV treatment to increase the CD4 count to a higher and safer level.<\/p>\n<h2 id=\"research\">Research<\/h2>\n<p>Several drugs for treating CMV are in development. However, this research is not seen as urgent because ART has greatly reduced the number of cases of CMV retinitis.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Type of infection CMV (cytomegalovirus) is a very common viral infection that most people are not aware of. CMV is common and widespread. Over 50% of the general population, over 60% in intravenous drug users and over 90% in gay &hellip;<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":199,"menu_order":8,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-217","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/i-base.info\/ttfa\/wp-json\/wp\/v2\/pages\/217","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/ttfa\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/i-base.info\/ttfa\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/ttfa\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/ttfa\/wp-json\/wp\/v2\/comments?post=217"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/ttfa\/wp-json\/wp\/v2\/pages\/217\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/i-base.info\/ttfa\/wp-json\/wp\/v2\/pages\/199"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/ttfa\/wp-json\/wp\/v2\/media?parent=217"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}