Clinical consequences of asymptomatic cytomegalovirus in treated human immunodeficency virus infection

Purpose of review Despite antiretroviral therapy (ART)-mediated viral suppression, people with human immunodeficiency virus (HIV) (PWH) have increased morbidity and mortality. Immune activation and inflammation persist on ART and predict these complications. Over 90% of PWH have cytomegalovirus (CMV) co-infection, and CMV is considered a plausible contributor to this persistent immune activation. Recent findings A detailed understanding of the link between CMV and multimorbidity is needed, particularly as research moves toward identifying potential targeted therapeutics to attenuate inflammation-mediated morbidity and mortality in treated HIV. We review the literature on the association between CMV and immune activation as well as multiple end-organ complications including cardiovascular disease, venous thromboembolic disease, metabolic complications, gastrointestinal dysfunction, central nervous system involvement, birth sex-related differences, and the relation to the HIV reservoir. We conclude with a discussion of ongoing therapeutic efforts to target CMV. As CMV is a plausible driver of multiple comorbidities through persistent immune activation in treated HIV, future research is needed and planned to address its causal role as well as to test novel therapeutics in this setting.

Automated summary

Despite viral suppression with antiretroviral therapy, people with HIV still experience increased morbidity and mortality due to persistent immune activation and inflammation. Cytomegalovirus (CMV) co-infection is common in PWH and is believed to contribute to this immune activation. Future research is needed to further investigate the causal role of CMV in driving comorbidities in treated HIV and to explore new therapeutic strategies targeting CMV.