Changing trends in cytomegalovirus disease in HIV-infected patients.

Treatment with combination antiretroviral therapy has transformed the natural history of human immunodeficiency virus (HIV) infection. Effective antiretroviral therapy results in both reduced risk of cytomegalovirus (CMV) disease and prolonged survival following CMV disease. These effects seem to be mediated by the reconstitution of immune responses against CMV, which results in re-established host control of CMV replication. As a result, some individuals have been able to discontinue maintenance therapy for CMV with a low risk of disease recurrence to date. The risk of development or progression reappears in the context of antiretroviral failure--a problem increasingly recognized in clinical practice. However, improved immune function is not always beneficial. Indeed, previously uncommon inflammatory complications have been associated with immune reconstitution following highly active antiretroviral therapy. The natural history of CMV disease at a time of rapid changes in treatment strategies remains uncertain and, therefore, individuals at risk continue to require careful management.