Emery V, Sabin C, Feinberg J, Grywacz M, Knight S, Griffiths P; Conference on Retroviruses and Opportunistic Infections.

Program Abstr 6th Conf Retrovir Oppor Infect Conf Retrovir Oppor Infect 6th 1999 Chic Ill. 1999 Jan 31-Feb 4; 6th: 153 (abstract no. 459).

Royal Free and University College Medical Schools, London, UK.

Viral load is a risk factor for disease in many human viral infections, especially HIV. We investigated the relationship between CMV viral load, antiviral chemotherapy and disease progression in HIV+ve patients enrolled in a randomised controlled trial comparing valaciclovir with aciclovir. Samples of blood and urine were collected at baseline, week 4, week 8 and then every 8 weeks from 310 patients. Samples were tested by qualitative and quantitative competitive PCR for HCMV DNA. Kaplan-Meier plots and proportional hazards regression analysis were used to examine the relationships between HCMV load, CMV disease and death. In univariate analyses, elevated viral load in blood and urine at baseline were associated with increased risk of HCMV disease (blood RH:1.47 per log increase, urine RH 1.49 per log increase). These effects remained after adjusting for treatment allocation and baseline CD4 count (blood RH: 1.49, urine RH: 1.46). Over the study period, valaciclovir significantly suppressed the viral load in patients who were PCR positive at baseline in either blood or urine when compared to the combined aciclovir arm. In time-updated analyses, the presence of HCMV DNA and elevated viral load throughout the study period in both blood and urine were significantly associated with increased progression to HCMV disease. In contrast the effect of VACV became of borderline significance. These data show that high HCMV load in HIV+ve patients increases the risk for disease and adversely impacts on survival. The clinical benefit of receiving valaciclovir as part of the ACTG 204 trial was directly related to the inhibition of HCMV replication.

Publication Types:

• Meeting Abstracts

Keywords:

• AIDS Vaccines
• Acquired Immunodeficiency Syndrome
• Acyclovir
• Antiviral Agents
• CD4 Lymphocyte Count
• Cytomegalovirus
• Cytomegalovirus Infections
• Cytomegalovirus Retinitis
• DNA Replication
• Disease Progression
• HIV Infections
• HIV Seropositivity
• Humans
• Polymerase Chain Reaction
• Risk Factors
• Valine
• Viral Load
• genetics
• valacyclovir

Other ID:

• 20711698

UI: 102195228

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