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

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.