Profile of Cytomegalovirus Infection in HIV-infected Children in Cipto Mangunkusumo Hospital
Shofa Luthfiyani ,Dina Muktiarti,Nia Kurniati
Background : Cytomegalovirus (CMV) infection is associated with severe opportunistic infection in an advanced HIV infection and contributed in accelerating HIV progression. CMV infection caused 8 – 10% AIDS-defining illness in the pre-antiretroviral (ART) therapy with CMV retinitis as the most common clinical finding in adult. However, the diagnosis of CMV is challenging, especially in a limited resources country. This study aimed to describe HIV-CMV co-infection cases and the outcome in Indonesian children.
Material : A descriptive study was conducted in Cipto Mangunkusumo Hospital and included 31 HIV-infected children who diagnosed with CMV infection.
Results : From 31 patients, 20 patients (64.5%) were male and most of them (13; 41.9%) age 1 – 5 years old. The diagnosis was made mostly before commencement of ART (14; 45.1%), and 2 cases were considered immune reconstitution inflammatory syndrome. CMV hepatitis was the most common clinical finding (10; 32.3%), followed by prolonged fever (9; 29.0%) and CMV retinitis (7; 22.6%). The mean CD4 at the time of CMV diagnosis was 385 cell/mm3 (11.2%). The IgM was reactive in 11 out of 23 patients (47.8%) and the IgG in 19 out of 22 patients (86.4%). The PCR was positive in 13 out of 14 patients (92.9%) and 9 cases positive from urine specimens (64.3%). Sixteen out of 25 patients (64.0%) were given Gancyclovir as the initial treatment. Prophylaxis with Valgancyclovir was given to 11 patients (35.5%). All of the patients survived after the therapy. Complication such as blindness and oxygen dependent were found in 3 (9.7%) and 3 (9.7%) patients, consecutively. Most of the patient (20; 64.5%) still visit the hospital for routine examination until now.
Conclusions : CMV infection should be suspected in HIV-infected children who had very low CD4 with manifestation of unexplained fever, liver or vision problem.
Keywords: HIV Cytomegalovirus Pediatric
Disclaimer: The Views and opinions expressed in the articles are of the authors and not of the journal.
Mid City Hospital, 3-A Shadman II
Jail Road, Lahore ,Pakistan