ROLE OF ANTIGENEMIA ASSAY IN THE EARLY DIAGNOSIS AND PREDICTION OF HUMAN CYTOMEGALOVIRUS ORGAN INVOLVEMENT IN AIDS PATIENTS

The role of an antigenemia assay in the diagnosis and prediction of hu man cytomegalovirus (HCMV) disease in AIDS patients was evaluated. The clinical history of 62 patients with advanced HIV infection from whom a total of 248 blood samples were drawn and tested by the HCMV antige nemia assay was examined retrospectively. Between December 1992 and Ja nuary 1994, 28 episodes of HCMV disease with organ involvement were re corded; the antigenemia assay was positive in 23 of them (82.1 %). In particular, this test was positive in 11 of 12 (91.6 %) first episodes and in 3 of 3 (100 %) recurrent episodes occurring in patients not re ceiving maintenance therapy. The same test was positive in 9 of 13 (69 .2 %) recurrent episodes occurring in patients receiving maintenance t herapy. The first occurrence of HCMV disease was always preceded by a positive antigenemia assay 2 and 4 months before diagnosis (in all 7 p atients of the 7 for whom a blood sample was available before HCMV dis ease). A positive antigenemia test result was not always followed by o rgan involvement, but a high positive cell count (> 100/200,000 polymo rphonuclear leukocytes) strongly correlated with the appearance of HCM V disease in the following 1 to 3 months(100 % of cases). The antigene mia assay is a useful and reliable indirect method for the diagnosis a nd prediction of HCMV endorgan disease in severely and persistently im munocompromised AIDS patients.