EVIDENCE OF ACTIVE CYTOMEGALOVIRUS-INFECTION IN CLINICALLY STABLE HIV-INFECTED INDIVIDUALS WITH CD4+ LYMPHOCYTE COUNTS BELOW 100 MU-1 OF BLOOD - FEATURES AND RELATION TO RISK OF SUBSEQUENT CMV RETINITIS/

To determine the frequency and significance of cytomegalovirus (CMV) v iremia and viruria in HIV-positive subjects with low CD4(+) lymphocyte counts but with no clinical indications for culture, we studied 100 c onsecutive clinically stable subjects with CD4(+) cells less than or e qual to 100/mu l of blood who agreed to culture of blood and urine. Se rum was tested for CMV antibody, p24 antigen, neopterin, and liver enz yme concentrations, and patients were offered funduscopic examination. Subjects' records were reviewed an average of 9.1 months after enroll ment for evidence of subsequent CMV retinitis. Three of the original c ohort proved ineligible because of CD4(+) count >100/mu l; CMV antibod y was present in 96% of the remainder. Isolation of CMV from blood was uncommon (2 of 93 seropositive subjects) whereas viruria occurred in 51.6%; likelihood of having a positive urine culture was significantly related to the subject's absolute CD4(+) lymphocyte count: 60% for th ose with CD4(+) less than or equal to 50/mu l, vs. 26.1% for those wit h CD4(+) 51-100/mu l. Neither serum p24 antigen nor neopterin was pred ictive of CMV in urine or blood. No subjects submitting to ophthalmolo gic exam had unsuspected CMV retinitis. Subsequent development of reti nitis correlated with CMV viruria on entry: 13.5% if urine-positive, 1 .9% if negative (p = 0.029; Fisher exact test).