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Revista médica de Chile

versión impresa ISSN 0034-9887

Resumen

MONDACA, Roberto et al. Cytomegalovirus infection in AIDS patients. An illustrative case series. Rev. méd. Chile [online]. 2020, vol.148, n.6, pp.778-786. ISSN 0034-9887.  http://dx.doi.org/10.4067/S0034-98872020000600778.

Background:

Cytomegalovirus (CMV) is an opportunistic infection (OI) in immunosuppressed patients. However, there are no clear cut-off values available for quantitative plasmatic CMV measures (viral load [VL]) to discriminate those with CMV illness from those infected suffering a transient viral reactivation.

Aim:

To estimate a CMV VL cut-off point that discriminates infected patients and those with CMV related diseases, and to clinically characterize AIDS patients with this OI.

Patients and Methods:

Retrospective analysis of AIDS patients admitted by any reason between years 2017 and 2019 and who had a positive plasma CMV VL at any titer. Cases were categorized with illness or infected using accepted criteria and the cut-off value was obtained by receiver operating characteristic curve (ROC) analysis.

Results:

Twelve patients were identified as having a CMV-associated illness and seven with CMV infection. A CMV VL of 3,800 copies/mL had a sensitivity of 91.6% and 100% specificity to discriminate both states. Of the 12 patients with CMV illness, all were in AIDS stage and only five were receiving HIV therapy. Predominant clinical presentations were gastrointestinal (50%), followed by liver involvement (25%) and CMV disease (25%). All patients were treated with ganciclovir or valganciclovir. Ten patients had a favorable response (83.3%), one patient only had a laboratory improvement (8.3%) and one died during treatment (8.3%). Drug toxicity was recorded in nine patients but in only three cases, a dose adjustment was necessary.

Conclusions:

The predominant clinical manifestation in our series was gastrointestinal. A CMV VL cutoff level of CMV VL of 3,800 copies / mL is useful to discriminate infected patients from those with CMV related disease.

Palabras clave : Acquired Immunodeficiency Syndrome; Cytomegalovirus; Patient Outcome Assessment; ROC Curve; Drug-Related Side Effects and Adverse Reactions.

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