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Editor,—The paper by Boriskin and colleagues1 provides interesting information regarding the age related contribution of cytomegalovirus (CMV) viral load in HIV infected children. The significantly higher CMV viral load in the youngest age group (0–2 years) could explain the generally higher mortality in this age group due to the accelerated disease progression.2 However, the conclusion regarding the progression of HIV infection associated with the CMV viral load in this cross sectional study1 should be treated with caution.
Between May 1985 and September 1995 we were able to follow from birth 25 vertically HIV infected children staged as A or B. We studied the clinical outcome with respect to CMV infection during 76 patient years.
Patients were divided into CMV negative (CMV IgG antibody negative and negative CMV cultures from urine samples; n = 12; median follow up 42 months (range (9–80)); and CMV infected (CMV IgG antibody positive; n = 13; median follow up 39 months (range 19–68)). In the CMV infected group 10 patients had positive urine samples for CMV on several occasions during observation. There was no primary CMV infection in the CMV negative group during follow up.
Clinical outcome of CMV negative patients was significantly better than CMV coinfected patients (4/12 v 11/13 progressed to AIDS; p < 0.02). The relative CD4 cell count used to assess disease progression was significantly different between the CMV infected and CMV negative group at the study end point (p < 0.01).
Pleskoff et al showed that CMV encodes a chemokine receptor, which also serves as a cofactor for the entry of HIV into cells.3 Furthermore, CMV is able to potentiate cellular immunodeficiency in HIV infection directly or due to coinfection with enhancement of HIV replication.4Therefore, a longitudinal study should be performed using CMV viral load to estimate the correlation of HIV and CMV coinfection for disease progression.