Chronic Viral Infections Common in Those with HIV | AIDS 2024

HIV virus © Yang MingQi - stock.adobe.com

Chronic viral infections from diseases such as herpes simplex virus (HSV), human papillomavirus (HPV) and cytomegalovirus (CMV) can have a serious impact on those with immune systems already compromised by HIV, according to a session held today at the International AIDS Conference in Munich, Germany. The session featured three speakers who discussed each of these diseases.

The first presentation was about CMV immune activation, by Lena Royston, M.D., Ph.D., from the Division of Infectious Diseases at the University Hospital of Geneva. CMV is in the herpes family and is extremely common. It is not considered a sexually transmitted infection. Most people will contract CMV in their lives but will only be symptomatic if they a have compromised immune system from another infection such as HIV.In advanced stages of HIV infection,CMV can lead to nausea, headaches, fever, confusion and even blindness, Royston said. CMV is currently in about 83% of the world's population, according to the National Library of Medicine.

“People living with HIV have the highest prevalence of the global CMV population,” Royston said.“We think that there might be some kind of synergy between the two viruses on immune activation and immunosenescence.” Immunosenescence refers to age-related changes in the immune system. As someone ages, their immune system typically weakens.

The main way CMV is treated is through antiviral drugs, which have a high rate of toxicity, leading to further complications.

The second discussion was about HPV, a viral infection, presented by Nelly Mugo, from the University of Washington in Kenya. An estimated 5% of all cancers are caused by HPV. About 85% of those cancers are cervical cancer, Mugo said. A 2023 study published in the Journal of Clinical Laboratory Analysis found that HPV exists in about 36.9% of HIV-positive individuals.

“In the HPV world, especially related cervical cancer, we know a lot, but we implement really poorly,” Mongo said. “We have very high recurrence amongst women living with HIV.”

“The road looks clear because we know what the pathogen is and what to do about it, we're unable to deliver so the outcome is still a distance away from us.”

The third presentation was about HSV by Anna Wald, M.D., a professor of epidemiology, medicine, and laboratory medicine at the University of Washington. She is also the director of the University of Washington Virology Research Clinic. The disease is characterized by painful blisters and ulcers and is often spread by sexual contact. People with HIV are two to three times more likely to contract HSV because the open sores provide a pathway for the virus to travel from partner to partner during sex. There are currently no biomedical interventions for HSV prevention that are extremely effective. It is not curable, but it can be managed with daily antiviral medication.

“I think there's a huge need for an accurate test,” Wald said. “People both with HIV and without HIV want to know their HSV status. We can't really control a disease unless we have reliable diagnostics.”

Wald recommends that HSV tests be available at home like COVID-19 tests,continuing condom usage and not having sex while lesions are present since this is how it is transmitted.