RAPID DETECTION OF CYTOMEGALOVIRUS IN BRONCHOALVEOLAR LAVAGE FLUID AND SERUM SAMPLES BY POLYMERASE CHAIN-REACTION - CORRELATION OF VIRUS ISOLATION AND CLINICAL OUTCOME FOR PATIENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Bronchoalveolar lavage (BAL) fluids and serum samples from 153 patient s with pulmonary symptoms who were infected with human immunodeficienc y virus (HIV) and underwent BAL were examined for the presence of cyto megalovirus (CMV) by conventional culture and by polymerase chain reac tion (PCR) for detection of CMV DNA. PCR detected CMV more frequently than did cultures of BAL fluid (PCR of BAL fluid, 53%; PCR of serum, 4 0%; and culture, 30%). In a multivariate model, development of extrapu lmonary CMV disease was predicted by the finding of CMV in BAL fluid b y culture (relative risk [RR], 8.0; confidence interval [CI], 3.8-16.8 ) or the finding of CMV DNA in serum (RR, 7.4; CI, 3.2-17.3) or BAL fl uid (RR, 8.0; CI, 3.1-20.7) by PCR. Mortality was found to be similar for patients who did or did not have CMV detected by either culture or PCR. Detection of CMV DNA by PCR was a more rapid and sensitive techn ique than conventional culture, Detection of CMV DNA in BAL fluid or s erum predicted subsequent development of extrapulmonary CMV disease bu t not death for HIV-infected patients with pulmonary symptoms.