Cytomegalovirus infection as a cause of pulmonary disease in HIV-infected patients
- James H Shelhamer, MD
James H Shelhamer, MD
- Deputy Chief, Critical Care Medicine Department, Clinical Center
- National Institutes of Health
Patients with HIV infection can present with fever, dyspnea, hypoxemia, and a chest radiograph showing diffuse pulmonary infiltrates (see "Approach to the HIV-infected patient with pulmonary symptoms"). Even in the era of highly active antiretroviral therapy, the most common etiologies of pneumonia in this setting are still Pneumocystis jirovecii; bacteria and a variety of other entities also enter the differential diagnosis, including cytomegalovirus pneumonia [1,2].
Although cytomegalovirus (CMV) may produce serious sequelae and death among organ transplant recipients (see "Prevention of cytomegalovirus infection in lung transplant recipients"), its significance as a pulmonary pathogen in HIV-infected patients is often unclear . The data regarding CMV as a pulmonary pathogen in patients with HIV infection and the prognosis and efficacy of treatment of CMV-related pulmonary disease in this setting will be reviewed here.
Autopsy studies are the most abundant source of evidence for CMV as a cause of pulmonary disease in HIV-infected patients. In a study of 75 autopsies of patients with HIV infection, 38 of whom were thought to have died of respiratory failure, 44 patients (59 percent) had histologic evidence of CMV infection . In over one-half of these patients, the CMV was thought to cause little or no pulmonary dysfunction. In contrast, CMV was thought to play some role in 21 of the 44 patients (as a sole pathogen in 6 patients and as a contributory pathogen in 15).
In another study of 54 patients who died with HIV infection, 31 patients (57 percent) had histologic evidence of CMV infection in the lung found at autopsy . One half of the patients with evidence for CMV pneumonitis were thought to have died of respiratory failure, although other causative agents were also found in most of these patients.
Therefore, histologic evidence of CMV pneumonitis is frequently present at autopsy in HIV-infected patients, but CMV is not commonly found as the sole pathogen.
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