Skip to main content
SpringerLink
Log in

Prognostic factors of survival of HIV-infected patients with Cytomegalovirus disease: Aquitaine Cohort, 1986–1997

  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

Objective: To analyse survival of HIV-infected patients who developed cytomegalovirus (CMV) disease and to identify prognostic factors of their survival. Methods: Cases of CMV disease diagnosed in the Aquitaine Cohort of HIV-infected patients (n = 4297) during the 1986–1996 period, were reviewed using standardised definitions. Follow-up was extended to December 1997. Cox model was used to determine factors associated with survival after the initial manifestations of CMV disease, considering protease inhibitor (PI) prescription and anti-CMV treatment as time dependent covariates. Results: 253 patients presented a CMV disease of which 221 (87.3%) died (median survival: 7 months). A better prognosis for survival was associated with: PI prescription [relative hazard (RH): 0.26; 95% confidence interval (CI): 0.11–0.59], anti-CMV treatment (RH: 0.37; CI: 0.25–0.54), CD4+ lymphocyte cell count > 50/mm3(RH: 0.66; CI: 0.47–0.94) and absence of neoplasia (RH: 0.70; CI: 0.52–0.94) whereas the disseminated CMV disease worsened prognosis (RH: 1.83; CI: 1.20–2.80). Conclusion: Antiretroviral treatment including PI, improved short-term prognosis of CMV disease regardless of its clinical manifestations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bowen E, Griffth P, Davey C, Emery V, Johnson M. Lessons from the natural history of cytomegalovirus. AIDS 1996; 10(Suppl 1): S37-S41.

    Google Scholar 

  2. Kaplan J, Masur H, Jaffe H, Holmes K. Preventing opportunistic infections in persons infected with HIV: 1997 guidelines. JAMA 1997; 278: 337-338.

    Google Scholar 

  3. Carpenter C, Fischl M, Hammer S, et al. Antiretroviral therapy for HIV infection in 1998. Updated recommandations of the international AIDS-society panel. JAMA 1998; 280: 78-86.

    Google Scholar 

  4. Dormont J. Stratégies d'utilisation des antirétroviraux dans l'infection par le VIH: Flammarion Médecine Sciences, Paris, 1998.

  5. BHIVA Guidelines Coordinating Committee. 1998 revision to the British HIV association guidelines for antiretroviral treatment of HIV seropositive individuals. Lancet 1998; 352: 314-316.

    Google Scholar 

  6. Katlama C. Consequences for the management of cytomegalovirus. AIDS 1996; 10(Suppl 1): S43-S46.

    Google Scholar 

  7. Masur H, Whitcup S, Cartwright C, Polis M, Nussenblatt R. Advances in the management of AIDS-related Cytomegalovirus retinitis. Ann Intern Med 1996; 125: 126-136.

    Google Scholar 

  8. Reed J, Schwab I, Gordon J, Morse L. Regression of Cytomegalovirus retinitis associated with protease-inhibitor treatment in patients with AIDS. Am J Ophtalmol 1997; 124: 199-205.

    Google Scholar 

  9. Cameron DW, Heath-Chiozzi M, Danner S, et al. Randomised placebo-controlled trial of Ritonavir in advanced HIV-1 disease. Lancet 1998; 351: 543-549.

    Google Scholar 

  10. Danner S. Management of Cytomegalovirus disease. AIDS 1995; 9(Suppl 2): S3-S8.

    Google Scholar 

  11. Matheron S, Chaput S, Gerbe J, et al. Effect of protease inhibitors on the incidence of CMV retinitis in HIV-infected patients. Sixth European Conference on clinical aspects and treatment of HIV-infection. Hamburg, Germany, 1997.

  12. Marimoutou C, Châne G, Dabis F, Lacoste D, Salamon R. Human immunodeficiency virus infection and AIDS in Aquitaine. 10 years' experience of a hospital information system, 1985-1995. Presse Med 1997; 26: 703-710 (French).

    Google Scholar 

  13. RNSP. Elargissement des critères de la catégorie “contamination hétérosexuelle” dans le cadre de la surveillance du SIDA en France. Bull Epidemiol Hebd 1996; (24): 108-109.

  14. Centers for Disease Control. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. Morbid Mortal Wkly Rep 1993; 41: 1-19.

    Google Scholar 

  15. Cox D. Regression models and life tables (with discussion). J Roy Stat Soc B 1972; 34: 187-220.

    Google Scholar 

  16. Beck B, Boeckh M, Lepenies J, et al. High-level sensitivity of quantitative pp65 Cytomegalovirus (CMV) antigenemia assay for diagnosis of CMV disease in AIDS patients and follow-up. J Clin Microbiol 1996; 34: 457-459.

    Google Scholar 

  17. Drouet E, Boibieux A, Michelson S, et al. Polymerase Chain Reaction detection of Cytomegalovirus DNA in peripheral blood leukocytes as a predictor of Cytomegalovirus disease in HIV-infected patients. AIDS 1993; 7: 665-668.

    Google Scholar 

  18. Saillour F, Bernard N, Ragnaud J, Morlat P, Blanchard Y, Monlun E. Incidence of Cytomegalovirus disease in the Aquitaine Cohort of HIV-infected patients: A retrospective survey, 1987-1993. J Infect 1997; 35: 155-161.

    Google Scholar 

  19. Saillour F, Bernard N, Dequae-Merchadou L, et al. Predictive factors of occurrence of Cytomegalovirus disease and impact on survival in the Aquitaine Cohort in France, 1985 to 1994. J Acquir Immune Defic Syndr 1998; 17: 171-178.

    Google Scholar 

  20. Jacobson M, Mills J. Serious Cytomegalovirus disease in the acquired immunodeficiency syndrome (AIDS). Ann Intern Med 1988; 108: 585-594.

    Google Scholar 

  21. Studies of ocular complications of AIDS Research Group in collaboration with the AIDS Clinical Trial Group. Mortality of patients with the Acquired Immunodeficiency Syndrome treated with either foscarnet or ganciclovir for Cytomegalovirus retinitis. N Engl J Med 1992; 326: 213-220.

    Google Scholar 

  22. Cheong I, Flegg P, Brettle R, et al. Cytomegalovirus disease in AIDS: The Edinburgh experience. Int J STD AIDS 1992; 3: 324-328.

    Google Scholar 

  23. Low N, Pfluger D, Egger M. Disseminated Mycobacterium avium complex disease in the Swiss HIV Cohort Study: Increasing incidence, unchanged prognosis. AIDS 1997; 11: 1165-1171.

    Google Scholar 

  24. Garly M, Petersen E, Pedersen C, Lundgren J, Gerstoft J. Toxoplasmosis in Danish AIDS patients. Scand J Infect Dis 1997; 29: 597-600.

    Google Scholar 

  25. Colford J, Segal M, Tabnak F, Chen M, Sun R, Tager I. Temporal trends and factors associated with survival after Pneumocystis cariniipneumonia in California, 1983-1992. Am J Epidemiol 1997; 146: 115-127.

    Google Scholar 

  26. Gallant J, Moore R, Richman D, Keruly J, Chaisson R, and the Zidovudine Epidemiology Studies Group. Incidence and natural history of Cytomegalovirus disease in patients with advanced Human Immunodeficiency Virus disease treated with zidovudine. J Infect Dis 1992; 166: 1223-1227.

    Google Scholar 

  27. Peters B, Beck E, Anderson S, et al. Cytomegalovirus infection in AIDS. Patterns of disease, response to therapy and trends in survival. J Infect 1991; 23: 129-137.

    Google Scholar 

  28. Holland N, Power C, Mathews V, Glass J, Forman M, McArthur J. Cytomegalovirus encephalitis in Acquired Immunodeficiency Syndrome (AIDS). Neurology 1994; 44: 507-513.

    Google Scholar 

  29. Rodriguez-Barradas M, Stool E, Musher M, et al. Diagnosing and treating Cytomegalovirus pneumonia in patients with AIDS. Clin Infect Dis 1996; 23: 76-81.

    Google Scholar 

  30. Chaisson R, Gallant J, Keruly J, Moore R. Impact of opportunistic disease on survival in patients with HIV infection. AIDS 1998; 12: 29-33.

    Google Scholar 

  31. Baillargeon J, Borucki M, Black S, Dunn K. Determinants of survival in HIV-positive patients. Int J STD AIDS 1999; 10: 22-27.

    Google Scholar 

  32. Palestine A, Polis M, de Smet MD, et al. A randomized, controlled trial of foscarnet in the treatment of Cytomegalovirus retinitis in patients with AIDS. Ann Intern Med 1991; 115: 665-673.

    Google Scholar 

  33. Drew W. Cytomegalovirus infection in patients with AIDS. Clin Infect Dis 1992; 14: 608-615.

    Google Scholar 

  34. Kaiser L, Perrin L, Hirschel B, et al. Foscarnet decreases Human Immunodeficiency Virus RNA. J Infect Dis 1995; 172: 225-227.

    Google Scholar 

  35. Jacobson M. Current management of Cytomegalovirus disease in patients with AIDS. AIDS Res Hum Retroviruses 1994; 10: 917-923.

    Google Scholar 

  36. Spira R, Marimoutou C, Binquet C, Lacoste D, Dabis F. Rapid change in the use of antiretroviral agents and improvement in a population of HIV-infected patients: France 1995 to 1997. J Acquir Immun Defic Syndr 1998; 18: 358-364.

    Google Scholar 

  37. Hammer SM, Squires KE, Hughes MD, Grimes JM, Demeter LM, Currier JS. A controlled trial of two nucleoside analogues plus Indinavir in persons with human immunodeficiency virus infection and CD4 cell counts of 200 per cubic millimetre or less. N Engl J Med 1997; 337: 725-733.

    Google Scholar 

  38. Walsh JC, Jones CD, Barnes EA, Gazzard BG, Mitchell SM. Increasing survival in AIDS patients with Cytomegalovirus retinis treated with combination an-tiretroviral therapy including HIV protease inhibitors. AIDS 1998; 12: 613-618.

    Google Scholar 

  39. O'Sullivan C, Drew W, McMullen D, et al. Decrease of Cytomegalovirus replication in human immunodeficiency virus infected-patients after treatment with highly active antiretroviral therapy. J Infect Dis 1999; 180: 847-849.

    Google Scholar 

  40. Komanduri K, Viswanathan M, Wieder E, et al. Restoration of Cytomegalovirus-specific CD4+ T-lymphocyte responses after ganciclovir and highly active antiretroviral therapy in individuals infected with HIV-1. Nat Med 1998; 4: 953-956.

    Google Scholar 

  41. MacDonald J, Torriani F, Morse L, Karavellas M, Reed J, Freeman W. Lack of reactivation of cytomegalovirus (CMV) retinitis after stopping CMV maintenance therapy in AIDS patients with sustained elevations in CD4 T cells in response to highly active antiretroviral therapy. J Infect Dis 1998; 177: 1182-1187.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Unité INSERM 330, Université Victor Segalen Bordeaux 2, Bordeaux, France

    C. Binquet, F. Saillour & F. Dabis

  2. Centre d'Information et de Soins de l'Immunodéficience Humaine (CISIH), Centre Hospitalier Universitaire, Bordeaux, France

    F. Saillour & F. Dabis

  3. Service de Médecine Interne, Hôpital Saint André, Centre Hospitalier Universitaire, Bordeaux, France

    N. Bernard

  4. Service d'Ophtalmologie, Hôpital Pellegrin, Centre Hospitalier Universitaire, Bordeaux, France

    M.-B. Rougier

  5. Service d'Anatomo-pathologie, Hôpital Pellegrin, Centre Hospitalier Universitaire, Bordeaux, France

    F. Leger

  6. Service de Médecine Interne, Centre Hospitalier de la Côte Basque, Bayonne, France

    F. Bonnal

Authors
  1. C. Binquet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Saillour
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. Bernard
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M.-B. Rougier
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. Leger
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F. Bonnal
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. F. Dabis
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Binquet, C., Saillour, F., Bernard, N. et al. Prognostic factors of survival of HIV-infected patients with Cytomegalovirus disease: Aquitaine Cohort, 1986–1997. Eur J Epidemiol 16, 425–432 (2000). https://doi.org/10.1023/A:1007627508918

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1007627508918

Search

Navigation