愛滋病患巨細胞病毒（Cytomegalovirus）感染與感染管制

Cytomegalovirus Infection in Patients with Acquired Immunodeficiency Syndrome

巨細胞病毒（Cytomegalovirus, CMV）的感染在全世界是非常普遍，大部分卻是無症狀或是些微不適。健康的年輕族群可能會有單核球增多症後群（mononucleosis syndrome）發生，通常會自己痊癒。然而其初次感染在免疫功能不全的患者會很嚴重，大部分發生於接受器官移植患者及愛滋病患。愛滋病患的細胞媒介免疫有缺損情況時（CD+4淋巴球量＜50/µL），較容易有CMV的感染症，引發各種臨床疾病（如視網膜炎、食道炎、肺炎、腦炎等）。愛滋病患接受HAART（highly active antiretroviral therapy）療程也可以降低CMV標的器官（end-organ）感染症。CMV感染症之診斷應視臨床醫師對於此病毒感染之懷疑，加上病患的年齡及其臨床狀況做全盤的合理推論。現今的抗病毒藥ganciclovir、foscarnet、cidofovir可以用來治療CMV視網膜炎，其中只有ganciclovir、foscarnet可以例行性用來治療全身性CMV感染及其預防。愛滋病患若有性行為，建議應使用保險套作為預防傳播感染措施。

Cytomegalovirus (CMV) infection is very common worldwide, and most presentations of the infection are either silent or subclinical. Healthy young individuals may develop mononucleosis syndrome, in which most clinical manifestations are self-limited. However, primary infection of CMV may result in serious or even life-threatening situations in patients with immunocompromised status, especially those who are solid organ transplant recipients or who have acquired immunodeficiency syndrome (AIDS). Patients with AIDS with an impaired cell-mediated immune system (CD4 lymphocyte count < 50/µL) are at high risk for CMV infection, such as retinitis, esophagitis, pneumonitis, encephalitis. The incidence of end-organ infection caused by CMV may decrease when patients with AIDS receive highly active antiretroviral therapy. Diagnosis is mainly based on clinicians’ suspicions of CMV infection according to the age and clinical status of the patient. Currently, the antiviral agents ganciclovir, foscarnet, and cidofovir are available for treating CMV retinitis, and the former 2 drugs can be used routinely as treatment or as prophylaxis for systemic CMV disease. Patients with AIDS are advised to use condoms, if possible, to avoid CMV infection from sexual activity.