Diagnostic utility of a multiplex herpesvirus PCR assay performed with cerebrospinal fluid from human immunodeficiency virus-infected patients with neurological disorders

We used a multiplex nested-PCR assay for the simultaneous detection in cere brospinal fluid (CSF) of five human herpesviruses (HVs) (cytomegalovirus [C MV], Epstein-Barr virus [EBV], varicella-zoster virus [VZV], herpes simplex virus [HSV], and human herpesvirus 6 [HHV-6]) in a clinical evaluation of human immunodeficiency virus (HIV)-infected patients with neurological diso rders. This method, which has the advantages of being rapid and economical, would be of particular interest for the diagnosis of neurological syndrome s caused by more than one HV,We studied 251 CSF samples from 219 patients, HV DNA was demonstrated in 93 (37%) of the CSF samples (34% of the patients ). CMV was the HV most frequently detected in our patients (25%), while EBV , VZV, HSV, and HHV-6 DNAs were present in significantly fewer cases (7, 4, 3, and 1%, respectively), When results were compared with the final etiolo gical diagnoses of the patients, the multiplex HV PCR showed high specifici ty for the diagnosis of CMV and VZV neurological diseases and for cerebral lymphoma (0.95, 0.97, and 0.99, respectively). The sensitivity of the assay was high for CMV disease (0.87), was low for cerebral lymphoma (0.33), and was not evaluable for VZV disease due to the small number of patients with this diagnosis. Nevertheless, detection of VZV DNA had possible diagnostic value in four of the nine cases, and EBV DNA amplification always predicte d the diagnosis of cerebral lymphoma in patients with cerebral masses, Dete ction of HSV DNA was frequently associated with CMV amplification and fatal encephalitis. HHV-6 was not considered to have a pathogenetic role in the three cases in which it was detected. This multiplex HV PCR assay is a spec ific and clinically useful method for the evaluation of HN-infected patient s with neurological disorders related to HV.