CONTINUOUS DETECTION OF CMV DNA IN PLASMA OF PATIENTS WITH ADVANCED HIV-INFECTION IMPLIES THE POOREST PROGNOSIS

Background: The contribution of cytomegalovirus (CMV) to progressive H IV infection is still controversial. Objective: The occurrence of CMV DNA in the plasma of patients with advanced HIV infection was studied in relation to the development of clinical disease. Study design: Plas ma samples were collected every 2 weeks for 6 months, The patients hav e thereafter been followed clinically at least every 3 months. CMV DNA . was extracted and analysed by a nested PCR. Results: CMV DNA was rep eatedly detected in the plasma of five patients for more than 45 days (group 1). These patients also had very low CD4+ cell counts (51+/-41x 10(6)/1). Three patients in group 1 developed CMV complications and CM V was the cause of death in two cases. Two patients with anti-CMV IgM responses did not develop CMV complications. All five patients died at a mean of 17 months after CMV DNA became continuously detectable by P CR. In another six patients, CMV DNA was not or only sporadically dete cted (group 2). In these six patients, four are still alive after more than 3.5 years and only one patient developed CMV retinitis 3 years l ater. Conclusions: The presence of CMV DNA in plasma was frequent in 1 1 patients with advanced HIV infection. The continued presence of CMV DNA in plasma of the patients with low CD4+ cell counts was related to the development of clinical CMV disease and carried the poorest progn osis.