In HIV patients, which virus is the most common cause of serious opportunistic viral disease?

• A. EBV
• B. CMV
• C. HSV
• D. VZV

Answer: (B)

When the immune system is severely weakened, certain latent viruses become active and cause serious disease. CMV is a herpesvirus that remains latent and reactivates with advanced HIV/AIDS, making it the most common cause of serious opportunistic viral illness in this setting. It tends to cause vision-threatening CMV retinitis, as well as CMV colitis, esophagitis, and pneumonitis. While EBV is associated with lymphoproliferative diseases and oral hairy leukoplakia in HIV, it’s not the typical driver of the most common severe opportunistic viral infections. HSV and VZV can cause mucocutaneous lesions and, in disseminated form, other organ involvement, but they occur less frequently as the overall major opportunistic viral diseases seen in advanced HIV.