A PROSPECTIVE EVALUATION OF CLINICAL-CRITERIA AND POLYMERASE CHAIN-REACTION ASSAY OF CEREBROSPINAL-FLUID FOR THE DIAGNOSIS OF CYTOMEGALOVIRUS-RELATED NEUROLOGICAL DISEASES DURING AIDS

Objective: To study the predictive value of clinical criteria and poly merase chain reaction (PCR) assay of cerebrospinal fluid (CSF) for the diagnosis of cytomegalovirus (CMV)-related neurological disorders dur ing AIDS. Setting: Four infectious diseases departments in two tertiar y referral teaching hospitals in Paris, France. Design and participant s: One-year prospective study involving 164 consecutive immunosuppress ed HIV-seropositive patients undergoing lumbar puncture (LP). Methods: A tentative diagnostic classification, based on strict operational cr iteria and PCR assay of CSF, was performed at the time of LP. At the e nd of the study, tentative diagnoses and PCR results were blindly and independently compared with the firm diagnoses, based on central nervo us system histology, clinical outcome and/or viral culture of CSF. Res ults: The tentative diagnosis showed CMV-related neurological disease in 38 patients, and CMV DNA was detected in 42. Among the 88 patients for whom a firm diagnosis was possible, 26 had a diagnosis of CMV-rela ted neurological disease. The concordance between the tentative and fi rm diagnoses was 61%, with a kappa index of 0.40. In contrast, the sen sitivity and specificity of PCR were respectively 92 and 94%, with pos itive and negative predictive values of 86 and 97%. The presence of CM V DNA in CSF was associated with an increased risk of death (P<0.0001) . Conclusions: Unlike clinical criteria, PCR detection of viral DNA in CSF can be used reliably for antemortem diagnosis of CMV-related neur ological disease, a frequent complication of AIDS in this study. This rapid method should make a major impact on the management of these pat ients.