Incidence and Prognosis of CMV Disease in HIV--Infected Patients before and after Introduction of Combination Antiretroviral Therapy

Byline: B. Salzberger (1), P. Hartmann (1), F. Hanses (1), B. Uyanik (2), O. A. Cornely (2), A. Wohrmann (2), G. Fatkenheuer (2) Abstract: Abstract Background: Highly active antiretroviral therapy (HAART) has improved the prognosis of HIV--infected patients. We studied the changes in the incidence and prognosis of cytomegalovirus (CMV) disease preceding and during the first few years of HAART in a clinic cohort. Patients and Methods: All patients with CMV disease diagnosed between 1993 and 1999 from a clinic cohort in Cologne, Germany, were included. The patients were followed until death or until December 31, 2001. The time period from 1993--1996 was classified as pre--HAART, the period from 1997--1999 as the HAART era. Survival was analyzed with a Cox--proportional hazard model. Results: From a total of 1,279 HIV--infected patients, 127 patients with CMV disease were enrolled. The incidence of CMV disease declined rapidly and significantly from 7.34 cases per 100 patient years (py) in the pre--HAART era to 0.75 cases per 100 py in the HAART era. The median survival time in the pre--HAART era was 9.5 months the median survival was not yet reached at 4 years of follow--up in the HAART era. The only risk factors influencing survival were CD4--cell count and antiretroviral therapy before and after diagnosis of CMV disease. Treatment naive patients had a better prognosis than pretreated patients and patients treated with triple combination therapy survived longer than patients with other treatment modalities. Conclusion: A rapid decline in the incidence of new CMV manifestations and a better prognosis of patients with CMV disease, especially if they were treatment naive and treated with triple combination therapy, were observed in the HAART era. Author Affiliation: (1) Klinik und Poliklinik I fur Innere Medizin, Universitatsklinikum Regensburg, 93042, Regensburg, Germany (2) Klinik I fur Innere Medizin, Universitatsklinikum Koln, Koln, Germany Article History: Registration Date: 01/01/2005 Received Date: 15/04/2005 Accepted Date: 14/06/2005 Article note: This paper is dedicated to the founders of the Walter Marget Foundation, D. Adam and F. Daschner, in gratitude for their support of the training in infectious diseases.