COMPARATIVE-ANALYSIS INTRATHECAL ANTIBODY-SYNTHESIS AND DNA AMPLIFICATION FOR THE DIAGNOSIS OF CYTOMEGALOVIRUS-INFECTION OF THE CENTRAL-NERVOUS-SYSTEM IN AIDS PATIENTS

We evaluated 49 paired cerebrospinal fluid (CSF) and serum samples of 35 patients infected with the human immunodeficiency virus type 1 (HIV -1) for laboratory evidence of cytomegalovirus (CMV) infection. The pa tients were grouped according to clinical criteria as probable CMV enc ephalitis/polyradiculomyelitis, CMV retinitis, cerebral toxoplasmosis, progressive multifocal leukoencephalopathy, HIV-1-related cognitive/m otor complex, HIV-1-associated myelopathy, and other neurological dise ases. Paired CSF and serum samples were analysed for CMV deoxyribonucl eic acid (DNA) by polymerase chain reaction (PCR), quantitative intrat hecal synthesis of immunoglobulin G (IgG) antibodies specific for reco mbinant phosphoprotein 150 (pp150) of CMV and CMV-specific serum IgM. Intrathecal synthesis of pp150-specific Ige was detected in 26% of pat ients (9/35), serum IgM was found in 23% of patients (8/35), and PCR o f CSF was positive in 11% of patients (4/35). Detection of CMV-specifi c DNA in CSF preceded the intrathecal antibody synthesis in three pati ents for whom serial samples were available. PCR results of the CSF be came negative in one patient with CMV polyradiculomyelitis after succe ssful therapy with 9-[2-hydroxy-1-(hydroxymethyl) ethoxymethyl] guanin e (DHPG). PCR has a higher diagnostic specificity in the acute phase o f CMV infection than intrathecal antibody synthesis. The serum IgM res ponse to CMV cannot be used to monitor a compartmentalized immune resp onse in the central nervous system while an intrathecal immune respons e seems to be associated with recovery either spontaneously or as a re sult of treatment.