Clinical characteristics and pathogenesis of cytomegalovirus colitis in HIV-infected patients
Objective. Determination of the incidence, clinical features, and pathogenetic mecha-nisms of cytomegalovirus (CMV) colitis in HIV-infected patients.Shakhgildyan V.I., Tishkevich O.A., Yadrikhinskaya M.S.
Materials and methods. A total of 653 patients with overt CMV infection were fol-lowed-up, of whom 196 (30.0%) had gastrointestinal involvement confirmed by esophagogastroduodenoscopy and colonoscopy. Seventy (35.7%) patients died. At au-topsy, autopsy specimens were collected from various sections of the intestine for sub-sequent macroscopic and microscopic examination. CMV colitis was confirmed by the detection of cytomegalovirus cells (CMСs) in biopsies and autopsies, as well as high concentrations of CMV DNA in whole blood and biopsy specimens.
Results. CMV colitis was diagnosed in 21.3% of patients with CMV infection and in 70.9% of patients with CMV gastrointestinal involvement. The clinical presentation of colitis was characterized by severe abdominal pain, moderate diarrheal colitis, signif-icant weight loss over a short period of time, extreme weakness, anorexia, and a pro-longed remitting febrile reaction with a fever reaching febrile levels. CMV colitis was characterized by chronic ulcerative necrotic lesions, primarily affecting the sigmoid and descending colon. Characteristic features included massive submucosal fibrosis, the presence of specific CMCs in the ulcerative lesions and vascular endothelium of the submucosal layer, and the development of vasculitis.
Conclusion. Ulcerative colitis is the most common form of intestinal pathology asso-ciated with CMV infection in the setting of HIV infection. Intestinal vascular involve-ment, with the development of vasculitis and ulcerated mucosa, plays a central role in the pathogenesis of the pathological process associated with CMV intestinal disease.
Keywords
cytomegalovirus
CMV
ulcerative colitis
vasculitis
HIV infection
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About the Authors
Vasily I. Shakhgildyan, Cand. Med. Sci., Senior Researcher, Central Research Institute of Epidemiology, Russian Federal Service for Surveillance of Consumer Rights Protection and Human Well-Being, Well-Being, Moscow, Russia; vishakh@yandex.ru; http://orcid.org/0000-0002-8686-0487.Marina S. Yadrikhinskaya, Resident physician, Moscow City Center for AIDS Prevention and Control, Moscow Healthcare Department, Moscow, Russia; rusalo4ka_88@mail.ru; http://orcid.org/0000-0002-9649-8522
Oleg A. Tishkevich, Рathologist, Infectious Clinical Hospital № 2, Moscow Healthcare Department, Moscow, Russia; tishol@mail.ru; https://orcid.org/0000-0002-0789-7709
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