Cytomegalovirus (CMV)

What Is Cytomegalovirus?

Cytomegalovirus (CMV) is a common virus. Over half of adults in the U.S. have it in their body by age 40. CMV spreads easily through an infected person’s saliva or other body fluids. It’s related to the herpes virus, which gives you cold sores.

If you have a healthy immune system that can easily control the virus, it usually doesn't cause problems. But it can make people who have weakened immune systems sick.

In people who have advanced HIV, CMV can cause an eye infection called retinitis that may lead to blindness. CMV retinitis is what’s known as an AIDS-defining condition. The virus could also affect your intestines, esophagus, lungs, brain, or nerves.

There are different types of cytomegalovirus infection.

• Congenital. This is when a baby gets CMV from its mother before birth.
• Primary. This is the first time someone gets CMV. It usually doesn’t cause symptoms, but some people may have signs that look like mononucleosis.
• Reactivation. An infection that has been dormant can become active again when your immune system is weakened. It can happen if you have advanced HIV, are in treatment for cancer, or have an organ transplant.

Cytomegalovirus Symptoms

General symptoms of primary CMV

Most healthy people who get CMV don't know it. If you have symptoms of primary CMV, they're mild and include:

• Fatigue
• Swollen glands
• Fever
• Sore throat
• Muscle aches

Less common symptoms of primary CMV

In rare cases, CMV can also cause:

• Changes to your personality
• Headaches
• Trouble concentrating
• Shortness of breath
• Dry cough

Symptoms of congenital CMV

Babies born with CMV might have:

• Premature delivery
• Small size or low birth weight
• Bruise-like rashes
• Yellow skin or eyes (jaundice)
• Swollen liver and spleen
• Small head (microcephaly)
• Seizures
• Hearing loss
• Pneumonia
• Liver inflammation (hepatitis)

Symptoms of CMV with HIV

If you also have advanced HIV, CMV can affect different parts of your body. You could have:

• Blind spots or moving black spots (floaters) in your eyesight
• Blurry vision
• Blindness
• Diarrhea
• Belly pain
• Trouble swallowing or painful swallowing because of ulcers in your mouth or esophagus
• Confusion
• Lower back pain
• Weight loss
• Fatigue
• Weakness in your legs

If you have HIV, you probably won’t get sick with CMV unless your CD4 count, a type of white blood cell, is below 100.

Cytomegalovirus Causes and Transmission

You probably won't catch CMV from casual contact. But you can get it by touching your eyes, nose, or mouth after having contact with an infected person's:

• Saliva
• Semen
• Vaginal fluids
• Blood
• Urine
• Breast milk

You can also get cytomegalovirus through:

• Sexual contact
• Blood transfusions
• Organ transplants

CMV spreads easily in places with lots of young children, like day-care centers, so anyone who spends time there is at higher risk of getting it. You’re also more likely to get the virus if your immune system is weakened because of a medication or another health condition.

Cytomegalovirus Tests and Diagnosis

Your doctor will order tests such as:

• Blood and urine tests. These include CMV antigen (a part of the virus), a virus culture, or PCR (a molecular test). Serologic tests look for things your immune system makes to fight CMV, called IgM and IgG antibodies, although most healthy people also have them.
• A biopsy. Your doctor takes a small sample of tissue from your intestines, your esophagus, or your lung and look at it under a microscope.
• Eye tests to check for inflammation in your retina.
• Imaging tests, like a CT scan, to look for changes in your lungs or brain.

Cytomegalovirus Treatment

When you have retinitis because of CMV, your doctor may give you strong medications intravenously (through a vein) for a couple of weeks, a process called induction therapy. After a while, they may switch you to pills.

You might have medication injected into your eye if your vision is in danger.

Your doctor might prescribe drugs including:

• Cidofovir (Vistide)
• Foscarnet (Foscavir)
• Ganciclovir (Cytovene)
• Maribavir (Livtencity)
• Valganciclovir (Valcyte)

These drugs generally can't cure the disease if you have advanced HIV, but they can control it while you get antiretroviral therapy (ART) for your HIV infection.

Depending on the medicine, you could have side effects including:

• Low white blood cell count (neutropenia), which raises your chance for other infections
• Feeling tired from low red blood cell count (anemia)
• Upset stomach or throwing up
Rash
• Kidney problems

Most important, if you take ART early in an HIV infection, the drugs will keep it from getting worse and will keep you from getting CMV in the first place.

Cytomegalovirus Complications

It’s rare, but CMV can cause complications including:

• Mononucleosis
• Guillain-Barre syndrome
• Brain inflammation (encephalitis)
• Heart inflammation (myocarditis)

In people with HIV, complications include:

• Retinitis
• Pneumonia
• Skin rashes and lesions
• Problems in the nerves, esophagus, lungs, colon, or mucous membranes
• Brain swelling

Complications in babies born with CMV include:

• Learning problems
• Cerebral palsy or trouble with muscle tone and coordination
• Seizures

Cytomegalovirus Outlook

There’s no cure for CMV. The virus stays inactive in your body and can cause more problems later. This reactivation is most common in people who’ve had stem cell and organ transplants.

Your outlook depends on your overall health. In people who have strong immune systems, CMV symptoms almost always go away on their own.

Congenital CMV can have lifelong effects. The risks are highest when the mother has their first CMV infection during a pregnancy.

If you have a weakened immune system, you might need treatment for the rest of your life to prevent complications.

Cytomegalovirus Prevention

CMV was once the most common viral opportunistic infection -- illnesses that are worse or happen more often in people with weakened immune systems -- tied to HIV. Now, ART can help keep your CD4 count up and your immune system strong. It can also help stop retinitis from coming back.

If you have advanced HIV, your doctor might also give you medicine to prevent CMV, in addition to your ART. But it's expensive, sometimes causes severe side effects, and may not work well. The most important thing is to take your ART medications daily as prescribed.

Talk to your doctor about your chance of getting CMV if you're having a blood transfusion.

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