title: Cytomegalovirus viral load testing of blood using quantitative polymerase chain reaction in acutely unwell HIV-1-positive patients lacks diagnostic utility.
abstract: We examined the usefulness of measuring cytomegalovirus (CMV) viral load (VL) in blood using quantitative polymerase chain reaction (qPCR) in establishing a diagnosis of CMV end-organ disease in consecutive unwell HIV-infected patients. The indication for testing for CMV, CD4 count, CMV VL and presence of CMV end-organ disease were abstracted from case-notes. During a 42-month period, 216 tests were performed in 181 patients; the majority (61%) had CD4 counts <100 cells/microL. The prevalence of detectable CMV by qPCR was 43.5% (94/216) with a prevalence of CMV end-organ disease of 7.4% (16/216). Of patients with CMV detectable by qPCR, 72 % (50/69) had CD4 counts <100 cells/microL. For patients with definite CMV end-organ disease, the positive predictive value of detectable CMV by qPCR was 10% (9/94), and the negative predictive value was 98% (119/122). In acutely unwell HIV-infected patients, detection of CMV by qPCR is a poor predictor of CMV end-organ disease.
authors.affiliation: Department of Genitourinary Medicine, Mortimer Market Centre, Camden Primary Care Trust, London WC1E 6JB, UK.
authors.forename: S G
authors.initials: SG
authors.lastname: Edwards
authors.forename: D
authors.initials: D
authors.lastname: Grover
authors.forename: C
authors.initials: C
authors.lastname: Scott
authors.forename: R S
authors.initials: RS
authors.lastname: Tedder
authors.forename: D
authors.initials: D
authors.lastname: Pillay
authors.forename: A
authors.initials: A
authors.lastname: Copas
authors.forename: R F
authors.initials: RF
authors.lastname: Miller
mesh_terms: D000208:Acute Disease; D003587:Cytomegalovirus / Q000235:genetics / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D004279:DNA, Viral / Q000032:analysis; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1; D006801:Humans; D016133:Polymerase Chain Reaction / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D019562:Viral Load / Q000379:methods*; D014766:Viremia / Q000097:blood* / Q000235:genetics
chemical_list: D004279:DNA, Viral