Cytomegalovirus antigenemia surveillance in the treatment of cytomegalovirus disease in AIDS patients

Objective: Surveillance of quantitative cytomegalovirus (CMV) antigenemia a mong AIDS patients with CMV treated complications in order to determine its value in assessing the response to treatment and survival. Methods: A longitudinal follow-up of antigenemia measurement at diagnosis, after induction therapy with ganciclovir or foscarnet, and every 3 months d uring maintenance therapy was carried out in 25 patients with CMV retinitis and in 8 with extraocular CMV disease. Positive antigenemia was defined as the presence of any amount of immunofluorescent pp65-positive leukocytes / 10(5) cells. Results: Mean antigenemia values were: 77+/-148 /10(5) leukocytes at retini tis diagnosis; 45+/-114 after induction therapy; and 7+/-18 and 1.5+/-4 aft er 6 months and one year of therapy, respectively. Patients achieving undet ectable antigenemia increased from 44% at baseline to 68% at postinduction and 80% during follow-up, Seven patients (28%) who remained free of relapse s presented significant minor baseline antigenemias and became negative aft er induction therapy. Patients with extraocular disease showed erratic anti genemia values and absent therapeutic response. CMV blood cultures before a nd after induction therapy were positive in 39% and 21% of patients, respec tively. Kaplan-Meier analysis revealed a significantly longer survival for patients with retinitis when compared to those with extraocular complicatio ns, and for patients with negative antigenemia after induction in compariso n with those who failed to achieve it. Conclusions: Low basal antigenemia and antigenemia clearance after inductio n therapy are variables directly related to good response to treatment and survival. Continuous surveillance of antigenemia during treatment could per mit designing of individual strategies to obtain a better response.