Area under the viraemia curve versus absolute viral load: Utility for predicting symptomatic cytomegalovirus infections in kidney transplant patients

A novel approach to predicting symptomatic cytomegalovirus (CMV) infections combines the level and the duration of viraemia in a single parameter. Six ty-four kidney transplant recipients were monitored by quantitative shell v ial culture, pp65 antigenaemia, and polymerase chain reaction (PCR) of leuc ocytes. The area under the curve (AUC) of each parameter was determined fro m the onset of viraemia to the beginning of antiviral treatment. The AUC va lues were significantly higher in symptomatic than in asymptomatic patients . For antigenaemia and PCR, optimal AUC thresholds for predicting symptomat ic CMV infections were determined. They were superior to standard cutoff le vels of absolute viral load in sensitivity, specificity, and positive and n egative predictive value. In 8 of the 23 patients who became symptomatic, i mpending clinical features were indicated earlier by the AUC thresholds tha n by standard viral load. In conclusion, the concept of the AUC should faci litate identification of patients at risk of symptomatic CMV infection. (C) 2001 Wiley-Liss, Inc.