Cytomegalovirus (CMV) viraemia detected by polymerase chain reaction identifies a group of HIV-positive patients at high risk of CMV disease
| Autor: | Bowen Ef, C. C. Davey, Caroline A. Sabin, P Wilson, Margaret Johnson, Paul D. Griffiths, Vincent C. Emery |
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| Rok vydání: | 1997 |
| Předmět: |
Adult
Ganciclovir Human cytomegalovirus medicine.medical_specialty Opportunistic infection Immunology Retinitis Polymerase Chain Reaction Asymptomatic Gastroenterology Predictive Value of Tests Risk Factors Betaherpesvirinae Internal medicine medicine Humans Immunology and Allergy Prospective Studies Viremia AIDS-Related Opportunistic Infections biology business.industry virus diseases Middle Aged Viral Load biology.organism_classification medicine.disease Infectious Diseases Cytomegalovirus Retinitis Viral disease medicine.symptom business Viral load Follow-Up Studies medicine.drug |
| Zdroj: | AIDS. 11:889-893 |
| ISSN: | 0269-9370 |
| DOI: | 10.1097/00002030-199707000-00008 |
| Popis: | Background: Cytomegalovirus (CMV) disease is a major cause of morbidity in patients with HIV infection. Despite treatment, CMV retinitis causes substantial visual loss, especially in patients with CD4 cell counts below 50 x 10(6)/l. Although routine ophthalmological screening of these patients has been recommended, no controlled trials have evaluated how frequently it should be performed. The aim of this study was to assess whether CMV polymerase chain reaction (PCR) results could direct ophthalmological screening to patients at high risk of CMV retinitis.Methods: In a prospective study of HIV-positive patients with CD4 cell counts below 50 x 10(6)/l, CMV viraemia was detected by qualitative PCR of whole blood. Patients who were CMV PCR-viraemic were allocated to monthly virological and ophthalmological follow-up; patients who were PCR-negative received 3-monthly virological and ophthalmological follow-up. CMV viral load was determined in all CMV-positive samples using a quantitative competitive PCR.Results: Nineteen out of 97 patients developed CMV disease over the first 12 months of the study. Sixteen (59%) out of 27 patients who were CMV-positive developed disease compared with three (4%) out of 70 of patients who were PCR-negative (P = 0.0001). A positive CMV PCR result was significantly associated with the development of disease (P = 0.0001), with a relative hazard of 20.15 [95% confidence interval (CI), 5.80-69.98]. Median CMV viral toad was significantly higher in those individuals who went on to develop CMV disease (P = 0.02). In PCR-positive patients, each 0.25 log,, increase in viral load increased the risk of disease (relative hazard, 1.37; 95% CI, 1.15-1.63; P = 0.0004).Conclusions: CMV PCR predicts the development of CMV disease and can be used to target ophthalmological resources to those patients at highest risk of retinitis. Asymptomatic patients who are PCR-positive represent a high-risk group in whom controlled trials of pre-emptive therapy could be conducted. |
| Databáze: | OpenAIRE |
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