PREDICTIVE VALUE OF CYTOMEGALOVIRUS (CMV) ANTIGENEMIA AND DIGENE HYBRID CAPTURE DNA ASSAYS FOR CMV DISEASE IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED PATIENTS

Oral ganciclovir prophylaxis decreases the incidence of cytomegaloviru s (CMV) disease among persons infected with the human immunodeficiency virus (HN), but universal prophylaxis is not cost-effective. We evalu ated urine and peripheral brood mononuclear cell cultures, a qualitati ve and quantitative antigenemia assay, and a commercially available CM V DNA hybridization assay for their ability to predict CMV disease in 138 HIV-infected patients. During a median follow-up of 10 months, 23 patients (17%) developed CMV disease. The sensitivity, specificity, po sitive predictive value, negative predictive value, and mean lead time s for the antigenemia assay (with use of a threshold of 8 positive cel ls per 10(5) peripheral blood mononuclear cells as a positive) were 74 %, 91%, 63%, 95%, and 95 days, respectively. Corresponding figures for the DNA hybridization assay were 91%, 64%, 34%, 97%, and 152 days. Th ese assays can identify patients at increased risk of CMV disease and should allow a strategy of preemptive therapy to be tested.