Predictive value of cytomegalovirus (CMV) antigenemia and digene hybrid capture DNA assays for CMV disease in human immunodeficiency virus-infected patients.
Oral ganciclovir prophylaxis decreases the incidence of cytomegalovirus (CMV) disease among persons infected with the human immunodeficiency virus (HIV), but universal prophylaxis is not cost-effective. We evaluated urine and peripheral blood mononuclear cell cultures, a qualitative and quantitative antigenemia assay, and a commercially available CMV DNA hybridization assay for their ability to predict CMV disease in 138 HIV-infected patients. During a median follow-up of 10 months, 23 patients (17%) developed CMV disease. The sensitivity, specificity, positive predictive value, negative predictive value, and mean lead times for the antigenemia assay (with use of a threshold of 8 positive cells per 10(5) peripheral blood mononuclear cells as a positive) were 74%, 91%, 63%, 95%, and 95 days, respectively. Corresponding figures for the DNA hybridization assay were 91%, 64%, 34%, 97%, and 152 days. These assays can identify patients at increased risk of CMV disease and should allow a strategy of preemptive therapy to be tested.
Department of Medicine, University of Toronto, Ontario, Canada.
S
S
Walmsley
K
K
O'Rourke
C
C
Mortimer
A
A
Rachlis
I
I
Fong
T
T
Mazzulli
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000821:virology; D000328:Adult; D000956:Antigens, Viral / Q000097:blood*; D015331:Cohort Studies; D003587:Cytomegalovirus / Q000276:immunology / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000150:complications / Q000175:diagnosis* / Q000652:urine / Q000821:virology; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D009693:Nucleic Acid Hybridization; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity
D000956:Antigens, Viral; D004279:DNA, Viral