Cytomegalovirus viraemia has poor predictive value for the development of cytomegalovirus disease in patients with advanced HIV-infection

• Published in: The Journal of infection 1999-11, Vol.39 (3), p.187-192
• Main Authors: Wiselka, Martin J., Nicholson, Karl G., Rowley, Stephen, Bibby, Kim
• Format: Article
• Language: English
• Subjects: Adult; AIDS-Related Opportunistic Infections - etiology; AIDS/HIV; Biological and medical sciences; CD4 Lymphocyte Count; Cytomegalovirus Infections - diagnosis; Cytomegalovirus Infections - etiology; disease progression; Female; Follow-Up Studies; Human cytomegalovirus; Human immunodeficiency virus 1; Human viral diseases; Humans; Incidence; Infectious diseases; Male; Medical sciences; Middle Aged; Polymerase Chain Reaction; Prognosis; Prospective Studies; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viremia - diagnosis
• ISSN: 0163-4453; 1532-2742
• DOI: 10.1016/S0163-4453(99)90047-6

Objective: Cytomegalovirus (CMV) continues to be one of the most important opportunistic infections associated with human immunodeficiency virus (HIV) infection. This study investigated the value of CMV-viraemia in predicting the development of clinical CMV disease in patients with advanced HIV infection. Methods: This was a prospective observational study performed over a 2-year period between 1994–1996 in the Department of Infection and Tropical Medicine at Leicester Royal Infirmary. Adult HIV-positive patients attending a hospital clinic were included if they were CMV-seropositive with CD4 counts ≥50 cells/mm 3. Subjects were seen at approximately 6-weekly intervals in the clinic and were reviewed by an experienced ophthalmologist. Serum for CMV PCR was taken and stored at regular intervals and qualitative and quantitative PCR was performed at the end of the study period. The value of PCR in predicting the development of CMV disease was then assessed. Results: Twenty-six patients were followed up during the study period and 77 evaluable specimens were analysed for CMV PCR. Twenty-three (30%) samples were positive and 54 negative. Seven (27%) patients developed CMV disease (five retinitis alone, and two with retinitis and oesophagitis) during the study period. Viraemia was often intermittent and there was no significant difference in the proportions of patients with positive or negative tests who subsequently developed CMV disease. The sensitivity, specificity, positive and negative predictive values of the qualitative PCR were 71%, 47%, 33% and 82% respectively and 57%, 74%, 44% and 82% respectively for the quantitative PCR (>10 3 copies/ml). Conclusions: The results from this study, which was performed before the introduction of protease inhibitors, found that cytomegalovirus PCR was of limited clinical value in predicting the patients at greatest risk of developing CMV-disease and provided little useful prognostic information.