CMV neg vs CMV +

[eric48]

CMV question

Hi guys,

I have an unusual question in the back of my mind. In the phase 2 of the treatment where there is a slow decrease of VL until UD, mine seems to be on the low track, it worries me...

Statistically, CD4 have a life span of 6 months, which means that if the meds are successfull, the major part of remaining infected CD4 have died by month 6 and have released all of their remnant load

the tank (bathtub) is empty and the patient is UD (though not virus free because of very long lasting CD4 - memory cells and other yet-to-be-identified reservoirs)

Now, this is because the average lifespan of CD4 in the general population is 6 months. There is one (newly identified) exception to this : the CD4 life expectancy of CD4 in a CMV neg person is 20 months (not 6...)

reading through the forum , I have rarely identified anyone mentioning a Negative CMV status. This because CMV infection is very highly prevalent in the HIV community. (note I am talking here about CMV viral infection, that lots of people have, not the CMV associated disease itself, which is now more rare)

I am CMV neg. (so was Nestor). It would help a lot in my personal understanding of phase 2 dynamics, if those who know their CMV sero-status would answer the poll and if those CMV neg could share their experience about time to become UD.

(If you are not HIV+ and/or do not know your CMV sero-status, please, do not answer the poll, in order to avoid biasing the results)

Many Many many thanks in advance  Eric

[bocker3]

You probably haven't seen many mentions of folks being CMV- because the vast majority of the population (I'm talking over 75-80%, if memory serves me) are CMV+.  I'm NOT talking about the HIV+ population, I'm talking about the general population of adults in the US. 
I remember back in my Blood Bank days, that it was very difficult to obtain CMV- blood when newborns needed transfusions.

I'm not sure I fully understand the point of your poll -- but you are biasing it already because only folks who kow their CMV status can answer.

Mike

[JonE]

I am CMV neg. I was CMV neg in june, but could be poz now or at some point as it seems easy to get. The doc and I were talking about eye health, HIV, and CMV. She was going into a shpeel, then stopped herself and looked at my charts, was kind of shocked that I was neg. Just started meds, so I will be interested how fast the vl drops. It was around 170k. I get my next results early December. Interesting subject. 

[madbrain]

I tested CMV+ at the same time as HIV+. I don't see any correlation with the VL, it has always been low.
My last detectable VL was on 2/24, 332 copies. I went on meds 3/5 . On 3/26 VL was undetectable, 3 weeks from the first pill.

[eric48]

I don't see any correlation with the VL

Hi, while this is not the point of this threat, you may be interested to read.

http://blogs.poz.com/joseph/

(search for CMV)

the point of the thread is the life cycle of CD4s after meds have been initiated (not the VL itself)

and
http://www.natap.org/2010/HIV/102210_03.htm

but you are biasing it already because only folks who know their CMV status can answer.

you may be right, but what should answer someone who does not know their CMV status ?
I just preferred to keep is simple.

The research on CVM induced immuno-aging and HIV induced immuno -aging (for people whose meds have 'solved' the immunodepression issue) is an all new topic
Their was an interesting article in the body or Aidsmeds explaining the extent of what immuno-aging researcher and immuno depression researchers can learn from each other.
Could not find it again unfortunately

Thanks everyone for continuing answering this poll

Eric

[eric48]

was kind of shocked that I was neg.

My doc had the same reaction: apparently very rare (hence this poll)

My HIV doc told me it is acquired by saliva /kissing. This is the most commonly accepted understanding. Based on:
http://blogs.poz.com/joseph/

and recent infection reported by our dear Nestor in this forum, I must say I disagree.
It is MOSTLY  acquired by saliva /kissing in the general population.*
but Semen also caries the virus and swalloing semen (which is not a 'practice' of 'general population') is ALSO a possible pathway.

Since MOST people are CMV+, they do not care... But, me, I do...(and I would humbly suggest that you do to... future may tell what what great asset being CMV- is to your immune system)

Please note that MOST people aged over 90+ are CMV NEG

Eric

[vaboi]

Are they even researching for cures, vaccines, or ARV's to control CMV?  It sounds like to me its something that needs to be addressed at some point too.

[natthai]

maybe you can add a "I don't know my status" option to the poll

[eric48]

as much as there is a huge difference between AIDS and HIV infection (and its consequences : inflammation, no cure, premature aging) there is a huge difference betwen the CMV disease and the CMV infection  (and its consequences : inflammation, no cure, premature aging)

CMV is an HIV on the (very) slow track. The importance of remaining HIV neg is (mostly) of importance to the HIV neg individuals/community. In the same fashion he importance of remaining CMV neg is (mostly) of importance to the CMV neg individuals.

The relevance of being/remaining CMV neg is only for the CMV negs. The short terms benefits of being CMV neg are minor. The long term benefits (especially in the context of HIV induced aging) could be enormous (to the CMV negs - only - unfortunately)  

I quote this article:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813282/?tool=pubmed

which is unfortunately quite obscure to read...

----
Our work was driven in part by emerging data that chronic CMV infection can have profound detrimental effects on immune function as people age
----

apparently only 2% of HIV poz are CMV neg, but, for this tiny minority, remaining CMV neg is very important.

Most importantly this thread was initiated in order to gather patient experience on the following question:

Is there a relationship between time-to-UD and CMV seroneg status ?

And obviously, only CMV neg (and who know their CMV neg status) people (a tiny minority) can provide a feed back on this question.

This question is of importance to the CMV neg HIV poz, because, if I theorize properly, their time-to-UD will be longer than in the general HIV+ population and will therefore be
declared HAART virologic failure, whereas , they , in fact, are not...

Once again this topic is of importance to a very tiny minority of Hivers, but , for those concerned, this may  carry great implications.

CMV neg status seems so beneficial to the HIV + that some advnaced eserachers are listing treating chronic CMV infection (not CMV disease) in order to reduce HIV induced aging

http://www.slideshare.net/Vihorg/casablanca-2010-vih-nouvelles-stratgies-thrapeutiques-christine-katlama

(slide 12)

Thanks for feed back

Eric

[bocker3]

I still am not quite sure that I understand the point of this thread.  CMV is so widespread in both the HIV+ and HIV- community that I am not sure how one "remains" CMV-, short of sero-sorting which I suspect would be exceedingly difficult.

So short of causing UNNECESSARY fear and/or panic in some folks on this site, what possible good are you  doing here.  Your research is completely biased -- it is based on self-reporting and is open only to those who know (or think they know) their CMV status - there is nothing "random" involved here nor have I heard of any control group. 

Quite frankly I find this nothing more than using AM members as guinea pigs in your self-indulgent quest.  Your findings are already suspect because of your data collection.  You've made reference to a model in another thread that predicted VL of a member undergoing acute CMV infection with amazing accuracy.  However, we only have your word that your model's accuracy is true.  If you have it this buttoned up, perhaps you should be looking to get it published.

Again, I can not fathom the point of this beyond causing unnecessary fear.

Mike

[madbrain]

Is there a relationship between time-to-UD and CMV seroneg status ?

And obviously, only CMV neg (and who know their CMV neg status) people (a tiny minority) can provide a feed back on this question.

That's not "obvious" at all - that relationship can be shown not to exist, just look at the CMV+ individuals such as myself, which are the majority, and still have a very short time-to-UD .

Also, your poll only asks about CMV+ vs CMV-, not about time-to-UD . So how do you hope do find that relationship anyway ? Your reasoning is very flawed.

[madbrain]

Are they even researching for cures, vaccines, or ARV's to control CMV?  It sounds like to me its something that needs to be addressed at some point too.

CMV is in most cases dormant, there isn't much that needs to be controlled.

[madbrain]

Please note that MOST people aged over 90+ are CMV NEG

Eric

Where is your data on that ?
All signs point to higher CMV+ levels, the older you get.

http://informahealthcare.com/doi/abs/10.3109/00365548409073957

http://content.karger.com/ProdukteDB/produkte.asp?Doi=150157

[eric48]

However, we only have your word that your model's accuracy is true.  If you have it this buttoned up, perhaps you should be looking to get it published.

Indeed ... I am currently working on confronting model and cohort numbers. But, as you may figure out getting access to cohort numbers is no easy task. (unless yo can point me to an internet accessible database). I am also working on getting it published, but for this I would need:
- be sure that the model is robust
- find a server that can host calculations while providing security and privacy protection.

In order to verify any model/intuition about a situation it is important to observe and listen to what concerned people have to say.

I am merely trying to collect patient experience from HIV+/CMV- with regards to time to UD. And listen to what these people say.

As for : fear and/or panic in some folks on this site.

I humbly apologize if anyone has felt offended or threatened. This is not the intent.

CMV neg are representing less may be less than 2 % of Hivers . For reference LTNP or other (HIV -protected) subgroups represent less than 1 % . they are THEREFORE of interest.

The clinical and immunologic significance of co-infection HIV/CMV under HAART is an all new area of research.

data is scarce and difficult to interpret.

This article is may be one that provides the most relevant information for Hivers:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2813282/?tool=pubmed

Cytomegalovirus-Specific T Cells Persist at Very High Levels during Long-Term Antiretroviral Treatment of HIV Disease

this one here is a bit off topic but of interest too...

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2939591/?tool=pubmed

If anyone here is HIV+/CMV-, please kindly post or PM as I am trying to collect personal patient experience.
personal patient experience of HIV+ / CMV+ or CMV? readers is of lesser interest to this thread.

Once again please excuse me if some how this thread is hurting your feelings.

Thanks again

Eric

[eric48]

CMV is in most cases dormant, there isn't much that needs to be controlled.

Hi,

In your reply, I have replaced CMV by HIV and I found that quite interesting...

CMV is not dormant. It is controlled by the immune system... Just like HIV... until it is no more...

Eric

[madbrain]

Hi,

In your reply, I have replaced CMV by HIV and I found that quite interesting...

CMV is not dormant. It is controlled by the immune system... Just like HIV... until it is no more...

Eric

I find it very uninteresting that you just make things up. How can you even compare the 2 ?

With untreated HIV, there is a well documented progression to AIDS. Where is your evidence about CMV progression ?

[bocker3]

Once again please excuse me if some how this thread is hurting your feelings.

It's not about hurt feelings -- it's about causing what I believe to be unnecessary worry or fear about CMV.  I have yet to hear any doctors telling patients to worry about CMV or that spend time monitoring CMV.  Why?  because with HAART the major CMV issue for HIV+ folks (CMV retinitis) is rarely seen.

For you to continually equate CMV and HIV is beyond my comprehension.  The significance of each is so wildly different in most people as to make this comparison laughable.

If CMV caused such "immuno-aging" as you say -- the life-expectency would probably being going downward in the US. 

So, while I don't see any harm in your asking folks for their experiences and or "data" -- please stop making wild claims as to the clinical relevance of this, for this is where I see unnecessary fear starting in others.

To be clear -- I in no way mean to minimize those who have had bad acute CMV infection -- my emphasis in this post is on the chronic state that the OP is pushing here.

[Assurbanipal]

If CMV caused such "immuno-aging" as you say -- the life-expectency would probably being going downward in the US. 

Huh?  Is there an implicit assumption here that CMV prevalence is changing?  If prevalence is consistent over time there would be no effect causing changes in life expectancy (constant levels of CMV prevalence would already be "built in")

More to the point, Eric I'm always quite suspicious of conclusions based on examing 2 % of a sample.  If the conclusions are going to hold up one had best have a quite large sample (this study only had under 700 people in total) or have a good understanding of the statistical basis. I've not spent a lot of time on the study, but are you convinced that the results they are getting are all actually significant? 

[eric48]

studies suggest that hallmark age-associated changes in peripheral blood T cell subset distribution may not occur at all in people who are not infected with this virus (quoted from the link below)

Interestingly, enough, and to ease the feelings of CMV+ people, some researchers are speculating that CMV could have a PROTECTIVE effect, especially in younger age.

It would be like a 2 sided coin.

Because CMV is transmitted in a large portion by the mother, the child/infant/adolescent/adult/ immune system is activated. The Fireworkers (CD8s) are on permanent alert

Yet, the other side of the same coin, because of being under permanent, chronic, low level stress, the  system 'ages' (actually CMV at older age seems to affect CD8s more than CD4s)

Because the system is on permanent alert, the person is better protected at young age, but, at older age, the protective system gets exhausted.

All research on CMV /immunosenescence is difficult because the only group studied (so far) is the elderly. It is a very difficult group to study, as comorbidities are more common and cohorts are small (and very few people care to know why the very elderly die...)
This research will be boosted as a new group with well documented cohorts is joining the fray: the (faster) aging HIV treated. (and funding for research will be actively requested)

An other point of interest, is the evidence of premature aging in HIV treated women (vs men).
It is also quite interesting to know that in order for the 'protective' CMV virus to be transmitted from mother to baby, CMV+ women have an increased level of CMV activity during pregnancy.
Maybe this is unrelated... May be not.

the  conjecture of CMV related immuno aging is discussed here:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2939591/?tool=pubmed
Immunosenescence and Cytomegalovirus: where do we stand after a decade?

The initial conjecture is that there is would be an underlying Transmitted Immuno Senescence Syndrome (I coined the name mimicking the AIDS acronym) in the  elderly

Assurb,

I admit the size of the cohort is modest (700). But, so far this is the best I could find. If someone could point to more convincing data, I'd appreciate.

Once again the aim of this thread is to try to assess:
- prevalence of CMV- in HAART treated HIV+ (from a community perspective, short of having access to 'official' cohorts)
- personal patient experience of CMV neg, with regards to the phase 2 in VL decay , once HAART is started. (the hypothesis being that phase 2 decay could be slower in CMV neg than in CMV poz)

Nothing less and nothing more.

Many thanks again for comments and feedback.

Eric

[eric48]

of interest...

http://www.aidsmeds.com/articles/hiv_inflammation_valcyte_1667_20289.shtml

April 20, 2011

Anti-CMV Drug Reduces HIV-Related Inflammation

eric

[newt]

Phase 2 of viral decay happens in a matter of weeks, 4-52 weeks generally. I don't see how CMV antibody status has any bearing on this. Some people just need longer rather than shorter to get to an HIV viral load of 50 copies or less. My ex took a year to get to less than 50 on his HIV viral load and he is CMV-positive, I took nearly as long and I am CMV-negative.

- matt

[eric48]

In the abscence to cohort access, I have no other means to rule out the hypothesis being that phase 2 decay could be slower in CMV neg than in CMV poz than to hear from CMV negs and hear from them if their personnal experience goes against the hypothesis.

If even one or 2 CMV negs would come forward with personal experience that their time to UD (all other things considered) was relatively fast, then I'd give up on the idea.

Thanks!

Eric

[wolfter]

of interest...

http://www.aidsmeds.com/articles/hiv_inflammation_valcyte_1667_20289.shtml

April 20, 2011

Anti-CMV Drug Reduces HIV-Related Inflammation

eric

The authors are quick to point out that Valcyte can have serious side effects, including the suppression of bone marrow. For this reason, people should definitely not be adding Valcyte to their HIV regimens. What’s more, the study was so small and so short that there is no way to tell whether the reduction in CD8 cell activation will actually result in a meaningful improvement in CD4 counts or other health benefits. Nevertheless, the authors state that the result is large enough and strong enough to warrant a longer and larger study, especially in those with poor CD4 recovery despite effective ARV therapy.