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JAC Advance Access published online on July 28, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh396
© 2004 by The British Society for Antimicrobial Chemotherapy
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Leading article

Cytomegalovirus infection in the era of HAART: fewer reactivations and more immunity

Kathryn L. Springer 1 Adriana Weinberg 2*

1 Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
2 Department of Medicine, University of Colorado School of Medicine, Denver, Colorado, USA; Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA

* To whom correspondence should be addressed. E-mail: Adrianna.Weinberg{at}uchsc.edu.


  Abstract

The incidence of cytomegalovirus (CMV) disease, once the most common and highly feared viral complication of AIDS, has dramatically decreased with the advent of highly active antiretroviral therapy (HAART). HAART-associated changes in the epidemiology of CMV disease resulted from the increase in CMV-specific immune responses coupled with the decrease in CMV reactivation. However, CMV disease continues to afflict HIV-infected patients on HAART when CD4+ cell counts fail to rise above 100 cells/mm3 and when reconstitution of normal CMV-specific immune responses does not occur. The latter scenario may lead to recurrent or de novo CMV end-organ disease, or to the recently described CMV immune recovery vitritis. HAART-associated immune reconstitution offers unique opportunities to investigate the virological and immunological correlates of protection against CMV disease. Although the full extent of CMV-specific immune reconstitution has not been defined thus far, CMV-specific interferon-{gamma} production has been shown to be significantly associated with protection against CMV reactivation and recurrent disease.

Keywords: HIV; immune reconstitution; AIDS; opportunistic infections.
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