title: pp65 antigenemia as a marker of future CMV disease and mortality in HIV-infected patients.
abstract: We retrospectively evaluated the role of pp65 antigenemia (AGM) as a marker of cytomegalovirus (CMV) disease and mortality in 241 HIV-infected patients with fever. Of 225 patients in whom CD4 count was available, 189 (84%) had counts below 100/microL and 209 (92.8%) below 200/microL, 149 patients had negative AGM (AGM-) and 92 had positive AGM (AGM+), AGM+ patients were at a more advanced stage of HIV disease, as evaluated by CD4 count (p < 0.001) and prior AIDS diagnosis (p < 0.001). Overall, 29 patients (12%) presented concomitant CMV disease (18 retinitis): 24 (26%) in the AGM+ group and 5 (3.3%) in the AGM- group (p < 0.001). AGM had a negative predictive value of 96.6% but a positive predictive value of 26% which increased to 65% if a cut-off of > 10 CMV-positive cells/10(5) leukocytes was considered. The cumulative rate of future CMV disease at 3 months was 0% in AGM patients, 3% in patients with AGM 1-10/10(5) and 36% in patients with AGM > 10/10(5). In a multivariate analysis, no antiretroviral therapy, AGM+ and CMV disease were independently associated with mortality. The role of AGM as a marker of present CMV disease is limited. However, quantitative AGM may select patients at a high risk of future CMV disease. In addition, AGM may be a marker of shorter survival in severely immunosuppressed HIV-infected patients.
authors.affiliation: Infectious Disease Service, Ciutat Sanitària de Bellvitge, University of Barcelona, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Podzamczer
authors.forename: E
authors.initials: E
authors.lastname: Ferrer
authors.forename: A
authors.initials: A
authors.lastname: García
authors.forename: J M
authors.initials: JM
authors.lastname: Ramón
authors.forename: J
authors.initials: J
authors.lastname: Niubó
authors.forename: M
authors.initials: M
authors.lastname: Santín
authors.forename: G
authors.initials: G
authors.lastname: Rufí
authors.forename: J L
authors.initials: JL
authors.lastname: Pérez
authors.forename: R
authors.initials: R
authors.lastname: Martín
authors.forename: F
authors.initials: F
authors.lastname: Gudiol
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000368:Aged; D000956:Antigens, Viral / Q000097:blood; D015415:Biomarkers / Q000097:blood; D018791:CD4 Lymphocyte Count; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000401:mortality; D017726:Cytomegalovirus Retinitis / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010750:Phosphoproteins / Q000097:blood*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014763:Viral Matrix Proteins / Q000097:blood*
chemical_list: D000956:Antigens, Viral; D015415:Biomarkers; D010750:Phosphoproteins; D014763:Viral Matrix Proteins; C065418:cytomegalovirus matrix protein 65kDa