HIV and cytomegalovirus viral load and clinical outcomes in AIDS and cytomegalovirus retinitis patients: Monoclonal Antibody Cytomegalovirus Retinitis Trial.
OBJECTIVE
To determine the association of cytomegalovirus (CMV) viremia with mortality and CMV retinitis progression in newly diagnosed and relapsed CMV retinitis.


METHODS
Ancillary study of a randomized, placebo-controlled, phase III clinical trial.


METHODS
A total of 83 patients with AIDS and CMV retinitis, enrolled during the first phase of the Monoclonal Antibody Cytomegalovirus Retinitis Trial, were administered MSL-109 or placebo as adjuvant therapy for CMV retinitis.


METHODS
Mortality and CMV retinitis progression.


RESULTS
Treatment with MSL-109 did not predict either progression of CMV retinitis or mortality. Detection in plasma CMV DNA at baseline predicted mortality, but CMV antigenemia did not. CMV DNA was a better predictor of mortality than a high HIV viral load. Neither CMV DNA nor antigenemia predicted the progression of CMV retinitis. Among newly diagnosed patients, there was a decline in the proportion with detectable CMV viral load and CMV antigenemia in response to anti-CMV therapy. However, there was a rebound in CMV viral load to 25% and CMV antigenemia to 54.6% at 6 months. In relapsed patients, anti-CMV therapy was not associated with a change in the percentage with detectable CMV-DNA or CMV antigenemia over time.


CONCLUSIONS
In patients with AIDS and CMV retinitis, the detection of plasma CMV DNA was associated with a higher risk of mortality than was a high HIV viral load. Anti-CMV therapy provided a transient reduction in CMV viremia in newly diagnosed but not relapsed patients with CMV retinitis. Adjuvant therapy with MSL-109 was ineffective in clearing CMV-DNA and CMV antigen from the plasma.
Jabs
Douglas A
DA
Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Gilpin
Adele M Kaplan
AM
Min
Yuan-I
YI
Erice
Alejo
A
Kempen
John H
JH
Quinn
Thomas C
TC
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000628:therapy* / Q000821:virology; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000956:Antigens, Viral / Q000097:blood; D003587:Cytomegalovirus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D017726:Cytomegalovirus Retinitis / Q000150:complications / Q000628:therapy* / Q000821:virology; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D010919:Placebos; D016896:Treatment Outcome; D019562:Viral Load
D000911:Antibodies, Monoclonal; D000956:Antigens, Viral; D004279:DNA, Viral; D010919:Placebos; C409204:sevirumab