DIAGNOSIS OF CYTOMEGALOVIRUS-INFECTION OF THE NERVOUS-SYSTEM IN AIDS BY POLYMERASE CHAIN-REACTION ANALYSIS OF CEREBROSPINAL-FLUID

To evaluate the diagnostic relevance and the clinical impact of the ce rebrospinal fluid (CSF) polymerase chain reaction (PCR) for cytomegalo virus (CMV) DNA in the diagnosis of CMV infection of the central nervo us system (CNS), 220 acquired immune deficiency syndrome (AIDS) patien ts with neurological disease were examined. CSF was drawn 1-180 days b efore death, concomitantly with clinical neurological disease, and aut opsy was performed in all the cases. CMV DNA was detected in the CSF f rom 36 of 45 patients (82%) with CMV infection of the CNS, and in 2 of 175 without CMV infection of the CNS at autopsy. The sensitivity of t he method was 82%, the specificity 99%, the positive predictive value 95%, and the negative predictive value 96%. An extensive CMV ventricul itis or encephalitis was shown by histopathology in the majority of th e CSF PCR-positive patients with overt clinical encephalitis. Minor CM V lesions only, not likely to cause relevant clinical symptoms, were o bserved in some CSF PCR-positive patients, concomitant with other oppo rtunistic CNS diseases. CSF PCR is a reliable means for diagnosis of C MV infection of the CNS in patients with AIDS. A positive PCR result, however, requires careful interpretation in the individual clinical co ntext.