CMV neurologic disease in patients with AIDS:
- 3 syndromes: dementia, encephalitis with ventriculoencephalitis, ascending polyradiculomyelopathy
- ventriculoencephalitis: acute onset with confusion, focal deficits, cranial nerve abnormalities, ataxia
- MRI: may demonstrate periventricular enhancement (also can be seen with CNS lymphoma/EBV)
- detect via CSF PCR or antigen assays; antibodies are not useful (although negative anti-CMV IgG makes CMV infection unlikely
HIV updates – fresh off the press from this week in NEJM: 2 important recent trials and a trial update supporting starting ARVs in patients diagnosed with HIV regardless of the CD4 count worldwide!
- START trial (strategic timing of ARV treatment): large RCT compared initiation of ARVs at CD4 count >500 and <350. Results: 72% relative reduction in AIDS related events and 39% reduction in non-AIDS related events in patients starting ARVs at higher CD4 count
- Temprano trial: 2×2 factorial design in the ivory coast comparing early ART, 6-month isoniazid preventive therapy, or both among HIV patients with high CD4 counts: immediate ART and 6 months of isoniazid preventive therapy independently led to lower rates of severe illness
- HPTN052 update: – Showed a sustained 93% reduction in HIV transmission with ART use within HIV discordant couples
The INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. DOI: 10.1056/NEJMoa1506816
The TEMPRANO ANRS 12136 Study Group. A trial of early antiretrovirals and isoniazid preventive therapy in Africa. N Engl J Med. DOI: 10.1056/NEJMoa1507198
M Cohen, et al . Final results of the HPTN 052 randomized controlled trial: antiretroviral therapy prevents HIV transmission. Program number MOAC0106LB, Track C.