Gastrointestinal Cytomegalovirus Infection in a Homosexual Man With Severe Acquired Immunodeficiency Syndrome

Gertler, Stanford L.; Pressman, Jeffrey; Price, Pamela T.; Brozinsky, Steven; Miyai, Katsumi

doi:10.1016/s0016-5085(83)80025-0

Cited by 62 publications

(7 citation statements)

References 10 publications

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“…A number of viruses have been implicated in the aetiology of diarrhoea in HIV‐infected patients and the list has grown and changed as advances have been made in diagnostic virology. One of the first viral OIs to be listed as an AIDS defining illness was Cytomegalovirus (CMV) 25 . CMV affects multiple organs in end stage HIV and in the GIT can cause colitis.…”

Section: Infectionsmentioning

confidence: 99%

Review article: the aetiology, investigation and management of diarrhoea in the HIV-positive patient

Feasey

Healey

Gordon

2011

Alimentary Pharmacology &Amp; Therapeutics

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SUMMARY BackgroundDiarrhoea is a common presentation throughout the course of HIV disease. AimTo review the literature relating to aetiology, investigation and management of diarrhoea in the HIV-infected adult. MethodsThe PubMed database was searched using major subject headings 'AIDS' or 'HIV' and 'diarrhoea' or 'intestinal parasite'. The search was limited to adults and to studies with >10 patients. ResultsDiarrhoea affects 40-80% of HIV-infected adults untreated with antiretroviral therapy (ART). First-line investigation is by stool microbiology. Reported yield varies with geography and methodology. Molecular and immunological methods and special stains have improved diagnostic yield. Endoscopy is diagnostic in 30-70% of cases of pathogen-negative diarrhoea and evidence supports flexible sigmoidoscopy as a first line screening procedure (80-95% sensitive for CMV colitis), followed by colonoscopy and terminal ileoscopy. Radiology is useful to assess severity, distribution, complications and to diagnose HIV-related malignancies. Side effects and compliance with ART are important considerations in assessment. There is a good evidence base for many specific therapies, but optimal treatment of cryptosporidiosis is unclear and only limited data support symptomatic treatments. ConclusionsThe immunological response to HIV infection and antiretroviral therapy remains incompletely understood. Antiretroviral therapy regimens need to be optimised to suppress HIV while minimising side effects. Effective agents for management of cryptosporidiosis are lacking. There is an urgent need for enhanced regional diagnostic facilities in countries with a high prevalence of HIV. The ongoing roll-out of antiretroviral therapy in low-resource settings will continue to change the aetiology and management of this problem, necessitating ongoing surveillance and study.

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Section: Infectionsmentioning

confidence: 99%

Review article: the aetiology, investigation and management of diarrhoea in the HIV-positive patient

Feasey

Healey

Gordon

2011

Alimentary Pharmacology &Amp; Therapeutics

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“…Of the many specimens from which CMV may be isolated, such as blood, saliva, various tissues, and semen, the latter is a particularly rich source of virus (1,5,(13)(14)(15)18) and is believed to be an important vehicle for transmission of the putative agent of AIDS (25) and CMV within homosexual (1,3,19) and, undoubtedly, heterosexual groups (9, 13) as well. Even though appropriate test systems are used, CMV isolation is frequently complicated by cell monolayer destruction due to toxicity of semen (1,(13)(14)(15) and the extensive time, in excess of 6 weeks, required to detect characteristic cytopathic effect (CPE) (3,6,18,23). Although dilution of semen specimens before inoculation into cell culture has been used to reduce monolayer toxicity (5, 9, 13-15, 18, 19, 25), it can often extend the time to initial CPE detection or may result in isolation failure.…”

mentioning

confidence: 99%

“…The presenice of CMV in semen may reflect viral shedding from other sites with spillover or direct extension of virus from infected cells within the genital tract. Cytological and hybridization studies have demonstrated CMV within human (6,8,12,13,16) and mouse (4) reproductive tracts, suggesting that viral replication in a variety of tissue and cell types is likely.…”

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confidence: 99%

Elimination of toxicity and enhanced cytomegalovirus detection in cell cultures inoculated with semen from patients with acquired immunodeficiency syndrome

Howell¹,

Miller²,

Bruckner³

1986

J Clin Microbiol

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Although semen is a particularly rich source of cytomegalovirus (CMV) and is useful for monitoring CMV shedding, its culturing is associated with extensive monolayer toxicity, isolation failures, and lengthy detection times. Inoculation of fractionated semen with immunoperoxidase staining of monolayers eliminated virtually all toxicity, increased isolation rates and monolayer infectivity, and greatly reduced detection times. Semen specimens (n = 73) were processed conventionally (C) or separated into supernatant (SF) and cellular pellet (PF) fractions, and 35% of C and SF inocula produced extensive toxicity. In contrast, virtually no toxicity was observed in monolayers inoculated with PF. C and SF isolation rates were 41 of 73 and 38 of 73, respectively, whereas that for PF was 51 of 73. Although monolayer infectivity at initial CMV detection was often <10% for C and SF, it was as much as 25% for PF. Average detection times were reduced from 13 days for C and SF to 6 days with PF and were further reduced to 3 days when PF inoculation was combined with immunoperoxidase staining. Thirty percent of specimens negative by C were positive by PF.

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“…Viruses are the common cause of diarrhea in HIV positive patients. CMV is an AIDS defining opportunistic infection presenting with diarrhea, [69] weight loss, fever and abdominal pain. Most common site of CMV enteritis is colon.…”

Section: (Iv) Viral Causesmentioning

confidence: 99%

Opportunistic agents causing diarrhea in HIV

Gupta¹,

Mohi²

2016

Journal of Gastrointestinal Infections

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Opportunistic infections (OIs) in Human Immunodeficiency Virus (HIV) infection continue to cause morbidity and mortality in HIV infected patients. Virtually all OIs occur when the CD4+T cell count 3 is less than 200/mm. The gastrointestinal (GI) tract is a common site for clinical expression of HIV. Diarrhea is the most common GI symptom in HIV/AIDS. Prevalence ranges from 0.9% to 14%. Diarrhea may be the presenting symptom of lymphoma and Kaposi's sarcoma. It may affect up to 40-50% of those taking anti-retroviral therapy (ART) and can be induced by other medications. It may also be the result of HIV-associated enteropathy. The agents can be classified as bacterial, parasitic, viral and fungal agents. Almost all bacterial diarrheic agents can cause diarrhea in HIV infected patients, including Clostridium difficile. Intracellular parasites like Isospora belli, Cryptosporidium parvum and Cyclospora are the main causative agents of diarrhea in HIV positive patients. Cytomegalovirus is an AIDS defining opportunistic infection. Candida is the main fungal agent of diarrhea in AIDS. Despite the availability of ART, OIs are common in India as HIV-infected persons in India present with an OI as the initial indicator of their disease. Some of them are aware of their HIV infection but do not take ART and some patients are enrolled in HIV care and prescribed ART but do not attain an adequate virologic and immunologic cure. Thus awareness about optimal strategies for diagnosis, prevention and treatment of OIs in GI tract is essential to provide comprehensive, high quality care for these patients.

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Gastrointestinal Cytomegalovirus Infection in a Homosexual Man With Severe Acquired Immunodeficiency Syndrome

Cited by 62 publications

References 10 publications

Review article: the aetiology, investigation and management of diarrhoea in the HIV-positive patient

Review article: the aetiology, investigation and management of diarrhoea in the HIV-positive patient

Elimination of toxicity and enhanced cytomegalovirus detection in cell cultures inoculated with semen from patients with acquired immunodeficiency syndrome

Opportunistic agents causing diarrhea in HIV

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