CLINICAL UTILITY OF CYTOMEGALOVIRUS URINE CULTURES FOR OPHTHALMIC CARE IN PATIENTS WITH HIV

Background - The utility of cytomegalovirus (CMV) urine cultures was c hecked in patients with HIV (a) to identify those at risk for CMV reti nitis and (b) to guide clinical decisions on treatment and prophylaxis of CMV retinitis. Methods - HIV infected patients were tested for CMV uria by shell vial cell cultures. The prevalence of CMVuria was relate d to CD4 count, HIV risk group, and time before and after diagnosis of CMV retinitis Results - A total of 639 shell cultures were obtained f rom infected ophthalmic patients. Only 4% of all patients with a CD4 c ount >400x10(6)/l shed. CMV in their urine compared with 42% with a CD 4 count less than or equal to 50x10(6)/l. Twenty three of 25 patients with CNV retinitis had a CD4 count less than or equal to 50x10(6)/l. A mong 130 patients with a CD4 count less than or equal to 50x10(6)/l (a ) those who were CMVuric had a nearly sevenfold risk (p<0.0001) of dev eloping CMV retinitis (35%) compared with those who did not shed CMV i n their urine (5%), and (b) CMVuria and CMV retinitis were more freque nt in homosexuals (58%/25%) than in intravenous drug users (23%/15%), More than 1 year before diagnosis of CMV retinitis 18% of patients wer e CMVuric compared with 83% of patients who were CMV culture positive in the last 3 months. CMVuria under virustatic maintenance therapy is associated with worsening of retinitis in two thirds of cases. Conclus ion - Ophthalmic screening of patients with HIV should include those w ith a CD4 count less than or equal to 50x10(6)/l and focus on the subg roup with additional CMVuria. Screening of other patients can be dropp ed without undue risk in order to spare AIDS patients unnecessary hosp ital visits. CMVuria as a single finding, however, does not justify an tiviral prophylaxis of CMV retinitis.