Viral, but not-COVID pneumonia in patients with HIV infection


DOI: https://dx.doi.org/10.18565/epidem.2021.11.3.69-77

Shakhgildyan V.I., Yadrikhinskaya M.S., Orlovsky A.A., Domonova E.A., Shipulina O.Yu., Tishkevich O.A., Ermak T.N., Yarovaya E.B.

1) Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow, Russia; 2) Moscow City Center for AIDS the Prevention and Control, Moscow, Russia; 3) M.V. Lomonosov Moscow State University, Moscow, Russia; 4) Clinical Infectious Diseases Hospital Two, Moscow Healthcare Department, Moscow, Russia
Objective. To describe the pathogenetic, clinical, and radiological features and to determine the clinical value of cytomegalovirus (CMV) DNA viral load in respiratory biomaterials and blood in CMV pneumonia in patients with HIV infection.
Subjects and methods. A total of 5485 HIV-infected patients (61.6% of cases had a CD4+lymphocyte count of < 200 cells/µl) were followed up; 593 people died. The investigators examined biomaterials for and determined the amount of pathogen DNA in secondary diseases, including CMV. Associations between the copy numbers of CMV DNA in the biomaterials and the presence of CMV pneumonia were sought for, by using the receiver operating curve (ROC) analysis.
Results. CMV pneumonia was detected in 343 (14.4%) of the 2376 cases of lung diseases. The paper presents the clinical and radiological characteristics of CMV lung lesions and describes their morphopathological features. It notes a statistically significant relationship between the HIV RNA viral load in blood, the indicators of the cellular component of immunity, and the amount of CMV DNA in the biomaterials, the probability of developing CMV pneumonia. According to the findings, CMV DNA ≥2.95 log in 105 leukocytes, ≥ 9000 copies/ml in plasma, ≥ 25 000 copies/ml in bronchoalveolar lavage, ≥ 3500 copies in 105 cells in bronchial tissue samples and ≥ 20 000 copies/ml in sputum confirm the diagnosis of CMV pneumonia with 95% probability. 
Conclusion. Late-stage CMV pneumonia is a common and severe problem in HIV-infected patients. Viral load assessment in blood and respiratory samples plays a key role in correct diagnosis.
Keywords: CMV DNA viral load, CMV pneumonia, HIV infection
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About the Autors

Vasily I. Shakhgildyan, Cand. Med. Sci., Senior Researcher, Central Research Institute of Epidemiology, Russian Federal Service for Surveillance of Consumer Rights Protection and Human Well-Being; vishakh@yandex.ru; http://orcid.org/0000-0002-8686-0487
Marina S. Yadrikhinskaya, Resident Physician, Moscow City Center for AIDS Prevention and Treatment; rusalo4ka_88@mail.ru; http://orcid.org/0000-0002-9649-8522
Aleksey A. Orlovsky, Laboratory Researcher, Laboratory for monitoring programs for Reduction of Mortality from Cardiovascular Diseases, National Medical Research Center of Cardiology, Ministry of Health of Russia; leha-orl@yandex.by; http://orcid.org/0000-0002-0794-4683.
Elvira A. Domonova, Cand. Biol. Sci., Head, Scientific Group for New Methods to Diagnose Opportunistic and Human Papillomavirus Infections, Department of Molecular Diagnosis and Epidemiology, Central Research Institute of Epidemiology, Russian Federal Service for Surveillance of Consumer Rights Protection and Human Well-Being; elvira.domonova@pcr.ms; http://orcid.org/0000-0001-8262-3938.
Olga Y. Shipulina, Cand. Med. Sci., Molecular Diagnostics Department, Central Research Institute of Epidemiology, Russian Federal Service for Surveillance of Consumer Rights Protection and Human Well-Being; olga.shipulinа@pcr.ms; http://orcid.org/0000-0003-4679-6772
Oleg A. Tishkevich, Pathologist, Clinical Infectious Diseases Hospital Two, Moscow Healthcare Department; tishol@mail.ru; https://orcid.org/0000-0002-0789-7709.
Tatiana N. Ermak, MD, Leading Research, Central Research Institute of Epidemiology, Federal Center of Hygiene and Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being; t.ermak@hiv-russia.ru; http://orcid.org/0000-0001-9490-7129
Elena B. Yarovaya, Doctor of Physical and Mathematical Sci., Professor, Department of Probability Theory, Faculty of Mechanics and Mathematics, M.V. Lomonosov Moscow State University; yarovaya@mech.math.msu.su; http://orcid.org/0000-0002-6615-43157129


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