Cytomegalovirus (CMV) DNA load is an independent predictor of CMV disease and survival in advanced AIDS

The impact of cytomegalovirus (CMV) on human immunodeficiency virus type 1 (HIV-1) disease progression has been controversial. In this study, we sough t to determine if CMV viral load is independent of HIV-1 viral load in pred icting CMV disease and survival. Our findings indicate that in patients wit h advanced AIDS, CMV DNA load is an independent marker of CMV disease and s urvival and is more predictive than HIV-1 RNA load. Moreover, patients who respond to preemptive therapy with oral ganciclovir, with resulting undetec table levels of CMV DNA, in their plasma, have a significantly lower risk o f developing CMV disease and higher rates of survival, despite stable or in creasing HIV-1 RNA loads. These data provide support for CMV as an independ ent risk factor for mortality in persons with advanced AIDS and further sug gest that effective preemptive therapy for CMV can improve patient survival rates.