DIAGNOSIS OF CYTOMEGALOVIRUS ENCEPHALITIS IN PATIENTS WITH AIDS BY QUANTITATION OF CYTOMEGALOVIRUS GENOMES IN CELLS OF CEREBROSPINAL-FLUID

A nested polymerase chain reaction (PCR) assay was used to determine t he levels of cytomegalovirus (CMV) genomes in cells of CSF from 19 pat ients with AIDS and 12 human immunodeficiency virus type I (HN-1) sero negative individuals with various neurologic disorders. Five AIDS pati ents had autopsy-proven CMV encephalitis (CMVE) and 14 patients had no evidence of CMV-related CNS manifestations. CSF cells from AIDS patie nts with confirmed CMVE harbored viral genomes at a median value of 3, 333/10(5) cells (range, 1,667 to 5,333/10(5) cells; mean, 3,558/10(5) cells) compared with a median value of 125/10(5) cells (range, 9 to 1, 000/10(5) cells; mean, 281/10(5) cells) for AIDS patients with CMV-unr elated symptoms and a median value of 19/10(5) cells (range, 0 to 562/ 10(5) cells; mean, 52/10(5) cells) for HIV-1 seronegative control subj ects. A subset of CSF samples was assessed using a modified single rou nd amplification PCR with a detection limit of 500 viral copies. CMV D NA was detected in all four specimens from AIDS patients with proven C MVE, in two of five AIDS patients without CMVE, and in none of five se ronegative control subjects. Quantitation of CMV genomes in CSF cells is indicative of latent or productive CMV infection and is a reliable means for diagnosis of CMVE in patients with AIDS. Detection of a cuto ff value of cellular CMV genomes by means of nonquantitative PCR may i dentify patients at risk for CMV infection of the CNS.