THE PREDICTIVE VALUE OF CYTOMEGALOVIRUS RETINITIS FOR CYTOMEGALOVIRUSENCEPHALITIS IN ACQUIRED-IMMUNODEFICIENCY-SYNDROME

Cytomegalovirus (CMV) infection of the brain, optic nerves, and retina s from 47 consecutive autopsies of patients with acquired immunodefici ency syndrome (AIDS) were examined. Immunocytochemistry demonstrated C MV infection in 11 (23%) brains, two (2%) of 94 optic nerves, and 38 ( 40%) of 94 retinas. Ten (91%) of 11 patients with CMV encephalitis had concurrent retinitis. While 10 (42%) of 24 patients with CMV retiniti s had CMV encephalitis, when the retinitis included the peripapillary region, 75% had encephalitis. Usually, the optic nerve parenchyma was not infected histologically despite extensive peripapillary retinitis. The strength of these associations suggests that CMV retinitis define s a group of patients with AIDS at risk for development of CMV encepha litis (relative risk, 9.5), particularly when the retinitis involves t he peripapillary region (relative risk, 13). Furthermore, in patients with AIDS without CMV retinitis, central nervous system symptoms are u nlikely to be attributable to CMV encephalitis.