CYTOMEGALOVIRUS ANTIGENEMIA IN ACQUIRED-IMMUNODEFICIENCY-SYNDROME PATIENTS WITH UNTREATED CYTOMEGALOVIRUS RETINITIS

PURPOSE: To determine the frequency of cytomegalovirus (CMV) viremia i n patients with acquired immunodeficiency syndrome (AIDS) and untreate d CMV retinitis using conventional cell culture isolation and the sens itive CMV antigenemia assay. METHODS: We examined 24 AIDS patients wit h ophthalmologic diagnosis of untreated CMV retinitis and 24 AIDS pati ents without present or past retinitis (control patients) from three m edical centers between September 1992 and March 1994. Cytomegalovirus antigenemia was detected by an indirect peroxidase staining in 300,000 cytocentrifuged neutrophils, using a mixture of murine monoclonal ant ibodies directed against the pp65 lower matrix protein of CMV. RESULTS : Positive antigenemia was demonstrated in eight (33.3%) of the 24 ret initis patients and in none of the 24 control patients (P <.001). Only two of the eight antigenemia-positive patients had a concurrent posit ive CMV isolation from blood leukocytes by conventional cell culture a ssay. CONCLUSIONS: These results emphasize the risk of extraocular dis ease in AIDS patients with CMV retinitis because the virus is often pr esent in peripheral blood leukocytes. The CMV antigenemia assay may be a simple and rapid means of identifying those patients with unilatera l retinitis at highest risk of developing CMV retinitis of the fellow eye or of visceral CMV disease if intravitreal injections or implants are used as sole treatment for CMV retinitis.