title: Cytomegalovirus (CMV) viremia and the CD4+ lymphocyte count as predictors of CMV disease in patients infected with human immunodeficiency virus.
abstract: We screened 192 patients infected with human immunodeficiency virus (HIV) to examine the relation between CD4+ lymphocyte counts and cytomegalovirus (CMV) viremia and the occurrence of CMV disease and subsequent duration of survival. When we stratified the viremic patients by CD4+ lymphocyte counts, the proportions were as follows: <50/mm3, 20 (25%) of 80 patients; 50-100/mm3, 2 (5.5%) of 36; 101-150/mm3, none of 14; and >150/mm3, 1 (1.5%) of 62. After a mean follow-up period of 8.5 months, 21 (11%) of 192 patients developed CMV disease. The probability of developing CMV disease at 6 months was 13% when the CD4+ lymphocyte count was <50/mm3, 3% when the CD4+ lymphocyte count was 50-100/mm3, and 0 when the CD4+ lymphocyte count was >100/mm3; this probability was 46% for viremic patients and 1% for nonviremic patients. In a multivariate analysis, CMV viremia was independently prognostic of CMV disease (relative risk, 22.03; 95% confidence interval, 6.49-78.97; P < .001), whereas a CD4+ lymphocyte count of <50/mm3 was not (P = .26). These results support the value of CMV viremia for predicting which HIV-infected patients are at risk of developing CMV disease and should therefore receive primary prophylaxis.
authors.affiliation: Department of Infectious and Tropical Diseases, Hôpital Bichat-Claude Bernard, Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Gérard
authors.forename: C
authors.initials: C
authors.lastname: Leport
authors.forename: P
authors.initials: P
authors.lastname: Flandre
authors.forename: N
authors.initials: N
authors.lastname: Houhou
authors.forename: D
authors.initials: D
authors.lastname: Salmon-Céron
authors.forename: J M
authors.initials: JM
authors.lastname: Pépin
authors.forename: C
authors.initials: C
authors.lastname: Mandet
authors.forename: F
authors.initials: F
authors.lastname: Brun-Vézinet
authors.forename: J L
authors.initials: JL
authors.lastname: Vildé
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers; D018791:CD4 Lymphocyte Count; D002648:Child; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011336:Probability; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014766:Viremia / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology
chemical_list: D015415:Biomarkers