Cytomegalovirus (CMV)-specific CD4(+) T lymphocyte immune function in long-term survivors of AIDS-related CMV end-organ disease who are receiving potent antiretroviral therapy

To better understand the relation of cytomegalovirus (CMV)-specific CD4(+) T lymphocyte immunity and clinical outcome in AIDS-related CMV end-organ di sease, 2 patient groups were prospectively studied: patients recently diagn osed with active CMV end-organ disease and survivors of CMV retinitis who h ad responded to highly active antiretroviral therapy and had quiescent reti nitis when anti-CMV therapy was discontinued. Most patients with active CMV disease had negative CMV-specific CD4(+) T lymphocyte responses at diagnos is, as measured by lymphoproliferation (7/7) or cytokine flow cytometry (3/ 5) assays. In contrast, all 10 subjects with quiescent retinitis and >150 a bsolute CD4(+) T lymphocytes/muL whose anti-CMV therapy was discontinued du ring 6 months of follow-up had positive CMV-specific immune responses at le ast once by each assay. However, 6 of these 10 subjects also had negative C MV-specific immune responses greater than or equal to1 time. Such patients may be at risk for future CMV disease progression and should be closely mon itored.