CIRCULATING CYTOMEGALIC ENDOTHELIAL-CELLS ARE ASSOCIATED WITH HIGH HUMAN CYTOMEGALOVIRUS (HCMV) LOAD IN AIDS PATIENTS WITH LATE-STAGE DISSEMINATED HCMV DISEASE

The prevalence of circulating cytomegalic endothelial cells, detected currently by the pp65-antigenemia assay and described previously in bl ood of transplanted and AIDS patients with disseminated human cytomega lovirus (HCMV) infection, was found to be 2.9% in the BIDS population and 6.5% in the fraction of the AIDS population with HCMV in blood. Cy tomegalic endothelial cells increased to 39.7% and 48.4%, respectively , in AIDS patients with very high levels of antigenemia and viremia, w hile an end organ disease reached an incidence of 76.4%. Positive and negative predictive values of cytomegalic endothelial sell detection f or diagnosis of HCMV end organ disease were 73.1% and 21.4% with antig enemia levers >1,000, respectively. On the other hand, in a selected g roup of 38 cytomegalic endothelial cell-positive AIDS patients with <5 0 CD4+ T cells/mu l and late-stage HCMV disease, who were followed-up for variable periods of time, the prevalence of high level antigenemia was 95.3%, that of viremia 86.0% and that of L-DNAemia 92.7%, while t he incidence of HCMV end organ disease was 84.2%. In this population, it was shown that cytomegalic endothelial cell presence was associated with lack of (56.0% of episodes) or insufficient (4.0%) anti-HCMV tre atment or emergence of HCMV drug-resistant strains (17.3%) err short-t erm response to antiviral treatment (22.7%); was determined in the sam e patient by different conditions during follow-up. Longitudinal obser vations indicated that cytomegalic endothelial cells were detected oft en in blood at least 3 months later than end organ disease suggesting that the duration of end organ disease was a cofactor associated with the appearance of cytomegalic endothelial cells. (C) 1998 Wiley-Liss, Inc.