Cytomegalovirus (CMV) polyradiculopathy related to AIDS is a distinct clinical syndrome, usually fatal if untreated and little described in the era of combined antiretroviral therapy (cART). The objectives of this study were to identify the prevalence of CMV-related polyradiculopathy and to describe its main characteristics and outcomes. A one-year retrospective cohort study at a tertiary center in São Paulo, Brazil. Adults living with HIV/AIDS (PLWHA) with CD4 cell count ≤ 100/mm³ and quantitative plasma CMV DNA testing collected at admission were included. Confirmed CMV polyradiculopathy was defined as the presence of subacute (or acute) onset leg weakness, accompanied by decreased deep tendon reflexes, qualitative detection of CMV DNA in CSF, and exclusion of other causes of polyradiculopathy. The prevalence of confirmed CMV polyradiculopathy was 1.2% (3/245). The three cases were male, presented CD4 < 50/mm³, concomitant extra-neural diseases in target organs by CMV, and high quantitative plasma CMV DNA results. In addition, they were empirically treated with ganciclovir ± foscarnet and cART in the first three weeks of hospitalization and were discharged from the hospital. CMV polyradiculopathy was uncommon among hospitalized PLWHA with severe immunosuppression. The baseline profile of these patients was similar to that described in the pre-cART era. The introduction of combined antiretroviral therapy and empirical antiviral therapy, the latter being justified by a high index of clinical suspicion, probably positively impacted the outcome. The quantitative detection values of CMV DNA in plasma were high in our patients with CMV polyradiculopathy, but their significance is still controversial. Finally, we propose an algorithm for the management of CMV polyradiculopathy in advanced HIV disease.
Souza et al. (Sun,) studied this question.