Late-Onset Cytomegalovirus (CMV) in Lung Transplant Recipients: Can CMV Serostatus Guide the Duration of Prophylaxis?
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Evidence supports the use of 12 months of cytomegalovirus prophylaxis in all at-risk lung transplants; whether cytomegalovirus serostatus can be used to further optimize this duration remains to be determined. The purpose of this retrospective study was to determine if cytomegalovirus serostatus of both donor and recipient were associated with late-onset cytomegalovirus. The primary outcome was the proportion of lung transplants that developed cytomegalovirus infection or disease during the 180-day period following 6 months of prophylaxis in each at-risk serotype. Two hundred forty-four consecutive lung transplants were evaluated, 131 were included. The proportion of recipients with cytomegalovirus differed significantly between serotypes (20 of 41 [48.8%] D+/R- vs. 19 of 56 [33.9%] D+/R+ vs. 2 of 34 [5.9%] D-/R+; p < 0.001). In a multivariate model, older age (odds ratio [OR], 1.05, 95% confidence interval [CI] 1.004-1.099; p = 0.03) and D+/R- serostatus (OR, 3.83; 95% CI 1.674-8.770; p = 0.002) were associated with cytomegalovirus. Among R+ lung transplants, D- serostatus was associated with the absence of cytomegalovirus (OR, 0.12; 95% CI 0.0263-0.563; p = 0.007). These findings suggest that in the valganciclovir era, cytomegalovirus serostatus of both donor and recipient may identify lung transplants at heightened risk for late-onset cytomegalovirus.Keywords:
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Cytomegalovirus
Persons living with HIV (PLWH) who are aware of their HIV status are more likely than serostatus-unaware PLWH to take precautions to prevent HIV transmission to their partners. The estimates of the Centers for Disease Control and Prevention (CDC) indicate that the proportion of PLWH who were aware of their serostatus increased between 2001 and 2004. The epidemiologic consequences of this increase in serostatus awareness are unknown.We developed a basic model of the US HIV epidemic from 2001 to 2004. Using this model, we calculated the number of incident infections that would have occurred in 2002 to 2004 had the proportion of PLWH who were aware of their serostatus remained at its 2001 level rather than increasing between 2001 and 2004. We then compared this incidence estimate with the CDC's estimated total of 120,000 incident infections in 2002 to 2004 to determine the number of infections prevented by the increase in serostatus awareness.The increase from 2001 to 2004 in the proportion of PLWH who were aware of their serostatus can be credited with preventing nearly 6000 incident HIV infections in the 3-year period from 2002 to 2004. Sensitivity analyses indicated a plausible range of 4000 to 8700 prevented infections.This analysis demonstrates the important epidemiologic benefits of increasing the proportion of PLWH who are aware of their HIV status.
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This study examines the association between drug and sexual HIV risk behaviours and knowledge of HIV serostatus among a sample of injection drug users, recruited into the 2009 National HIV Behavioral Surveillance project. We calculated prevalence ratios and associated 95% confidence intervals of reporting a given risk behaviour comparing injection drug users unaware of their serostatus and HIV-negative to HIV-positive injection drug users. Of 523 participants, 21% were unaware of their HIV serostatus. The three groups were not different from each other in terms of drug-use behaviours; however, injection drug users unaware of their HIV serostatus were 33% more likely to report having more than three sexual partners in the past 12 months and 45% more likely to report having unprotected sex compared to HIV-positive injection drug users. We observed markedly higher prevalence of sexual risk behaviours among injection drug users unaware of their serostatus, but drug-use risk behaviours were similar across the groups.
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We investigated the role of donor cytomegalovirus (CMV) serostatus on reactivation of CMV infection in CMV-infected transplant recipients. Reactivation of CMV infection occurred more frequently in patients receiving a CMV-positive graft but was less severe than in patients receiving a CMV-negative graft. These data suggest roles for both virus as well as CMV-specific immunity present in the graft.
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Cytomegalovirus infection in renal transplant recipients is a major clinical problem, with both short and long term sequelae. Infection can occur as a result of reactivation of latent virus or new infection from donor tissues. The impact of donor and recipient serostatus on viremia is well recognised, with seronegative recipients at greatest risk after transplantation of an organ from a seropositive donor. However, the impact of grafting such organs into seropositive recipients is less clear. To assess the impact of recipient serostatus on the risk of CMV antigenemia in a large renal transplant cohort. We prospectively quantified CMV antigenemia over time in a cohort of 486 recipients. We analysed the antigenemia status according to donor and recipient serostatus. Antigenemia was most common in seronegative recipients of organs from seropositive donors (D+/R−). Nevertheless, we observed that even in CMV seropositive recipients, the impact of donor serostatus on CMV antigenemia is still substantial (p = 0.006; OR = 2.2). In this large study, donor serostatus clearly plays a significant role in determining CMV risk, even in seropositive recipients.
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Abstract HIV serostatus disclosure among people living with HIV/AIDS (PLWHA) is an important component of preventing HIV transmission to sexual partners. Due to barriers like stigma, however, many PLWHA do not disclose their serostatus to all sexual partners. This study explored differences in HIV serostatus disclosure based on sexual behavior subgroup (men who have sex with men [MSM]; heterosexual men; and women), characteristics of the sexual relationship (relationship type and HIV serostatus of partner), and perceived stigma. We examined disclosure in a sample of 341 PLWHA: 138 MSM, 87 heterosexual men, and 116 heterosexual women who were enrolled in SafeTalk, a randomized, controlled trial of a safer sex intervention. We found that, overall, 79% of participants disclosed their HIV status to all sexual partners in the past 3 months. However, we found important differences in disclosure by subgroup and relationship characteristics. Heterosexual men and women were more likely to disclose their HIV status than MSM (86%, 85%, and 69%, respectively). Additionally, disclosure was more likely among participants with only primary partners than those with only casual or both casual and primary partners (92%, 54%, and 62%, respectively). Participants with only HIV-positive partners were also more likely to disclose than those with only HIV-negative partners, unknown serostatus partners, or partners of mixed serostatus (96%, 85%, 40%, and 60%, respectively). Finally, people who perceived more HIV-related stigma were less likely to disclose their HIV serostatus to partners, regardless of subgroup or relationship characteristics. These findings suggest that interventions to help PLWHA disclose, particularly to serodiscordant casual partners, are needed and will likely benefit from inclusion of stigma reduction components.
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Evidence supports the use of 12 months of cytomegalovirus prophylaxis in all at-risk lung transplants; whether cytomegalovirus serostatus can be used to further optimize this duration remains to be determined. The purpose of this retrospective study was to determine if cytomegalovirus serostatus of both donor and recipient were associated with late-onset cytomegalovirus. The primary outcome was the proportion of lung transplants that developed cytomegalovirus infection or disease during the 180-day period following 6 months of prophylaxis in each at-risk serotype. Two hundred forty-four consecutive lung transplants were evaluated, 131 were included. The proportion of recipients with cytomegalovirus differed significantly between serotypes (20 of 41 [48.8%] D+/R- vs. 19 of 56 [33.9%] D+/R+ vs. 2 of 34 [5.9%] D-/R+; p < 0.001). In a multivariate model, older age (odds ratio [OR], 1.05, 95% confidence interval [CI] 1.004-1.099; p = 0.03) and D+/R- serostatus (OR, 3.83; 95% CI 1.674-8.770; p = 0.002) were associated with cytomegalovirus. Among R+ lung transplants, D- serostatus was associated with the absence of cytomegalovirus (OR, 0.12; 95% CI 0.0263-0.563; p = 0.007). These findings suggest that in the valganciclovir era, cytomegalovirus serostatus of both donor and recipient may identify lung transplants at heightened risk for late-onset cytomegalovirus.
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Abstract The psychological sequelae of choosing to learn or not to learn one's HIV serostatus were examined in a group of 224 men who had been tested for HIV. Correlates of this avoidance were measured (a) when both groups had been tested and given the opportunity to receive the test results, and (b) after the group that initially chose to avoid HIV-serostatus information had learned their test results (and an equivalent time point for those who had already learned their HIV serostatus). Results indicate that those who kept themselves unaware of their serostatus had AIDS-related worries and concerns significantly higher than individuals aware that they were HIV seronegative and equivalent to individuals aware that they were HIV seropositive, at the first time point. Thus, unaware seronegative men suffered unnecessary worries and concerns. Both HIV-seropositive and HIV-seronegative men who were initially unaware showed a decline in mood disturbance on learning their HIV status. These findings suggest that learning threatening information may be more psychologically beneficial than avoiding it.
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Abstract We used the findings from two, cross-sectional studies of HIV serostatus and risk behaviours to assess the effects of knowledge of HIV serostatus and risk behaviours (relating to sex and injection drug use) among injecting drug users (IDUs). Respondent-driven sampling was used simultaneously at two sites in Estonia (the capital Tallinn, and the second-largest city of Ida-Virumaa County, Kohtla-Järve). The research tool was an interviewer-administered survey. Biological samples were collected for HIV testing. Participants were categorised into three groups based on HIV testing results and self-report on HIV serostatus: HIV-negative (n=133); HIV-positive unaware of their serostatus (n=75); and HIV-positive aware of their serostatus (n=168). In total, 65% of the participants tested positive for HIV. Of those 69% were aware of their positive serostatus. HIV-positive IDUs aware of their serostatus exhibited more risk behaviours than their HIV-positive counterparts unaware of their serostatus or HIV-negative IDUs. Effective prevention of HIV among IDUs should therefore, include programmes to reduce high-risk sexual and drug use behaviours at the public health scale and enhanced prevention efforts focusing on HIV-infected individuals.
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Failure of people living with HIV/AIDS to disclose their HIV serostatus can place their sexual partners at risk. The current study examined HIV serostatus disclosure and its relationship to risky sexual behaviours in 69 sexually active, heterosexual, married (62%) or cohabiting (38%) patients recently diagnosed as HIV positive. Results show that 78% had not disclosed their HIV serostatus to their sexual partners and 46% had no knowledge of their sexual partner's serostatus. Compared to those who disclosed their serostatus, those who did not disclose were more likely to be male (chi2 = 7.02, p = 0.00), to have not used a condom during their last sexual encounter (chi2 = 29.64, p = 0.000), to have used alcohol heavily before sex (chi2 = 6.79, p = 0.00), to have multiple sexual partners (t = 3.01, p = 0.05), and to have engaged more frequently in sexual intercourse in the six months preceding the study (t = 8.21, p = 0.00). Logistic regression analysis show that being in a married relationship (OR = 0.86, 95% CI = 0.65, 1.15), being male (OR = 1.48, 95% CI = 0.24, 1.99), having more than two multiple partners (OR = 2.03, 95% CI = 1.11, 3.68) and non-use of condom at last sex (OR = 1.53, 95% CI = 0.83, 1.88) were significantly associated with non-disclosure of HIV serostatus. Preventive strategies among HIV-positive patients should place emphasis on the management of self-disclosure and its importance in safe sexual behaviour.
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