Impacto da infecção pelo citomegalovírus na resposta imunológica e inflamatória de pessoas vivendo com HIV em terapia antirretroviral

Abstract

The coinfection between human immunodeficiency virus (HIV) and cytomegalovirus (CMV) represents a relevant factor in chronic immune activation and progression of immunosuppression, even among individuals receiving antiretroviral therapy (ART). Considering the high global prevalence of CMV and its role in modulating inflammation and humoral immune responses, this study aimed to evaluate the interaction between these two viruses in individuals undergoing ART. The objective of this study was to analyze CMV seroprevalence, antibody profiles (specific total IgG and IgG1, and IgG3 subclass), inflammatory markers (IL-6, IL-10, IFN-γ), and CD4⁺ and CD8⁺ T lymphocyte counts in HIVpositive patients HIV and CMV viral load. This was a cross-sectional cohort study conducted with patients followed at the HIV/AIDS outpatient clinic of HC-UFTM, in which CMV serology, viral DNA quantification by qPCR, and inflammatory cytokine measurements were performed. The seroprevalence of anti-CMV IgG was 54.4% among the 133 participants, with a mean age of 46 years. Viral suppression was associated with improved immune reconstitution, as evidenced by higher CD4⁺ T lymphocyte counts, a higher CD4/CD8 ratio, and a more robust humoral response against CMV, particularly with increased levels of IgG1 and IgG3 subclasses. No CMV viremia was detected in any sample, indicating control of latent infection. However, CMV seropositivity was associated with lower CD4⁺ counts and a reduced CD4/CD8 ratio, suggesting a persistent immunological impact of coinfection. Additionally, CMV-seronegative individuals exhibited higher levels of IFN-γ, IL-6, and IL-10, indicating that chronic CMV infection may modulate the inflammatory response, possibly through mechanisms related to immunosenescence and immune dysfunction. These findings reinforce that, even in the absence of detectable viral replication, CMV can influence immune dynamics in people living with HIV, highlighting the importance of virological control and monitoring of coinfection.