DIAGNOSING AND TREATING CYTOMEGALOVIRUS PNEUMONIA IN PATIENTS WITH AIDS

Because cytomegalovirus (CMV) can be isolated from pulmonary secretion s of human immunodeficiency virus (HIV)-infected patients without caus ing disease, its clinical significance as a cause of pneumonia in this patient population is frequently questioned. In a 22-month period, CM V pneumonia was diagnosed in 17 (8%) of 210 HIV-infected patients who underwent lung biopsy on the basis of microbiological and histologic c riteria. The clinical presentations of these patients were nonspecific , including fever (100% of patients), shortness of breath (71%), cough (76%), and PaO2 of <75 mm Hg (88%). A high correlation in the degree of viral burden in lung biopsy specimens was demonstrated by histologi c examination, immunohistochemical analysis, and in situ hybridization . No other pulmonary pathogens were identified for nine patients, wher eas other possible causes of pneumonia were present in eight; 11 patie nts had evidence of extrapulmonary CMV disease at presentation, Most p atients initially responded to specific anti-CMV therapy; the overall mean survival +/- SD was 3.1 +/- 2.5 months. CMV should be considered as a possible cause of pneumonia in patients with advanced AIDS especi ally if CMV infection is documented at other sites.