Cytomegalovirus in HIV: A Modifiable Driver of Inflammation, Frailty, and Aging.

IF 4.4 2区医学 Q2 INFECTIOUS DISEASES

Current HIV/AIDS Reports Pub Date : 2026-03-20 DOI:10.1007/s11904-026-00775-2

Alfonso Cabello Ubeda, Kristine M Erlandson, Michael L Freeman, Scott L Letendre, Celestine N Wanjalla, John R Koethe, Michael J Corley, Peter W Hunt, Sara Gianella

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Abstract

PURPOSE: Cytomegalovirus (CMV) infection is nearly universal among people with HIV (PWH) and contributes to chronic inflammation, immune senescence, and accelerated biological aging despite suppressive antiretroviral therapy (ART). This review summarizes recent advances in understanding the role of CMV in multimorbidity and aging in PWH, focusing on immune and tissue-based mechanisms, comorbidities, and emerging interventions. RECENT FINDINGS: CMV reactivation drives clonal T-cell expansion, innate immune reprogramming, adipose tissue inflammation, metabolic rewiring, and durable cellular epigenetic changes that amplify risks for vascular disease, frailty, brain health disorders, diabetes mellitus, and cancer. Early interventional data indicate that letermovir can reduce inflammation and improve immune and frailty outcomes in PWH, while vaccines are advancing in clinical evaluation. CMV is a modifiable driver of immune dysfunction and aging in PWH. Targeted antiviral, vaccine, and host-directed approaches may reduce multimorbidity and promote healthy aging, particularly in populations at greatest risk.

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HIV中的巨细胞病毒：炎症、虚弱和衰老的可改变驱动因素。

目的：巨细胞病毒（CMV）感染在HIV感染者（PWH）中几乎是普遍的，尽管采用了抑制性抗逆转录病毒治疗（ART），但巨细胞病毒（CMV）感染会导致慢性炎症、免疫衰老和加速生物衰老。本文综述了巨细胞病毒在PWH多发病和衰老中的作用的最新进展，重点是免疫和组织机制、合并症和新兴干预措施。最近发现：巨细胞病毒再激活驱动克隆t细胞扩增、先天免疫重编程、脂肪组织炎症、代谢重连接和持久的细胞表观遗传变化，这些变化增加了血管疾病、虚弱、脑健康疾病、糖尿病和癌症的风险。早期介入数据表明，莱特莫韦可以减少PWH的炎症，改善免疫和虚弱结局，而疫苗在临床评估中正在取得进展。巨细胞病毒是PWH患者免疫功能障碍和衰老的可改变驱动因素。靶向抗病毒、疫苗和宿主导向的方法可以减少多病并促进健康老龄化，特别是在高危人群中。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current HIV/AIDS Reports INFECTIOUS DISEASES-

CiteScore

8.10

自引率

2.20%

发文量

期刊介绍： This journal intends to provide clear, insightful, balanced contributions by international experts that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of HIV/AIDS. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as antiretroviral therapies, behavioral aspects of management, and metabolic complications and comorbidity. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.