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 intestinesesophaguslungsbrain, 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:

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:

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.

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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:

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:

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:

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.

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Cytomegalovirus Complications

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

In people with HIV, complications include:

Complications in babies born with CMV include:

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.

WebMD Medical Reference Reviewed by Jonathan E. Kaplan, MD on June 27, 2020

Sources

SOURCES:

CDC: "Frequently Asked Questions about CMV," "About CMV," "You Can Prevent CMV."

AIDS Treatment Data Network: "Cytomegalovirus."

eMedicine: "Cytomegalovirus."

American Academy of Family Physicians: "Cytomegalovirus."

UCSF Center for HIV Information: "Cytomegalovirus and HIV."

National Library of Medicine MedlinePlus Drugs & Supplements: "Valganciclovir."

News release, FDA.

National CMV Foundation: “CMV Transmission,” “Potential Outcomes of Congenital CMV.”

Nemours/KidsHealth: “Cytomegalovirus (CMV).”

Merck Manual Consumer Version: “Cytomegalovirus (CMV) Infection.”

American Association for Clinical Chemistry: “Cytomegalovirus (CMV) Tests.”

AIDS Info: “CD4 T Lymphocyte,” “What is an Opportunistic Infection?”

Australian Department of Health: “Cytomegalovirus.”

Infectious Diseases and Therapy: “Who Is the Patient at Risk of CMV Recurrence: A Review of the Current Scientific Evidence with a Focus on Hematopoietic Cell Transplantation.”

Mayo Clinic: “Cytomegalovirus (CMV) infection.”

Harvard Health Publishing: “Cytomegalovirus (CMV).”

U.S. Department of Veterans Affairs: “Cytomegalovirus (CMV).”

Cleveland Clinic: “Cytomegalovirus (CMV) in Transplant Patients.”

National Institute of Neurological Disorders and Stroke: “Neurological Consequences of Cytomegalovirus Infection Information Page.”

 

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