POLYRADICULOPATHY ASSOCIATED WITH GANCICLOVIR-RESISTANT CYTOMEGALOVIRUS IN AN AIDS PATIENT - PHENOTYPIC AND GENOTYPIC CHARACTERIZATION OF SEQUENTIAL VIRUS ISOLATES

To investigate the role of antiviral drug resistance in cytomegaloviru s (CMV) disease progression, CMV cultured from an AIDS patient who dev eloped progressive CMV disease despite continual anti-CMV treatment wa s characterized. In 7 CMV isolates, 1 ganciclovir-resistant strain pre dominated. Ganciclovir-resistant CMV, containing a UL97 mutation, was cultured from blood and urine before clinical indication of CMV centra l nervous system (CNS) disease, suggesting that the development of gan ciclovir resistance preceded the dissemination of CMV to the CNS. Quan titative competitive polymerase chain reaction indicated that the isol ation of ganciclovir-resistant CMV was concurrent with increased CMV D NA in plasma. The results suggest that antiviral resistance should be considered when selecting therapy for CMV CNS disease that develops in patients receiving treatment for CMV retinitis, In addition, plasma C MV DNA in AIDS patients receiving anti-CMV therapy may be a useful mar ker of disease progression and antiviral resistance.