RAPID PROGRESSION OF HIV DISEASE IN CHILDREN WITH CYTOMEGALOVIRUS DNAEMIA

Objective: In HIV-l-infected children, active cytomegalovirus (CMV) in fection can cause severe clinical manifestations and accelerate progre ssion of HIV disease. However, sufficient quantities of blood samples may not be available either for culture or detection of CMV DNA or ant igens in white blood cells. The aim of this study was to investigate t he diagnostic and prognostic significance of detecting CMV DNA in seru m samples from HIV-l-infected children. Design: Sera from 55 children (18 boys), aged 2-130 months (mean, 49.8 months), with perinatal HIV-1 infection and clinical manifestations attributable to CMV infection w ere tested for CMV DNA by nested polymerase chain reaction and for cla ss-specific CMV antibodies [immunoglobulin (Ig) G, IgA, IgM] by enzyme -linked immunosorbent assay. The children were followed up for 2 days to 59 months (mean, 25.5 months). Results: CMV infection was demonstra ted in 43 children (74.5%), 18 of whom (42%) were positive for CMV DNA . During the follow-up, 13 children with CMV infection (30.2%) died, i ncluding 11 (84.6%) who were positive for CMV DNAemia just before deat h. Of these children, seven died soon after hospitalization without an tiviral treatment, and four died despite therapy with ganciclovir or f oscarnet. Post-mortem CMV inclusions were revealed in seven out of eig ht children who underwent autopsy. The two other children who died als o had progressive CMV disease and received ganciclovir until death. In comparison with CMV-seropositive children without CMV DNAemia, childr en with CMV DNAemia showed significantly shorter mean survival time (4 2.5 versus 60 months; P < 0.01), lower final CD4+ T-cell count (218 ve rsus 499x10(6)/l; P < 0.01) and higher mortality rate (P < 0.0001). Co nclusions: The detection of CMV DNA in serum is of value for diagnosis of active CMV infection in HIV l-positive children, and CMV DNAemia i s a good prognostic indicator of severe outcome of HIV disease.