Aymptomatic CMV viremia is associated with increased levels of serum amyloid A in patients with advanced HIV-infection.
OBJECTIVE
We evaluated assays for the measurement of acute phase protein levels in plasma for their usefulness to identify sensitively an inflammatory response to active cytomegalovirus CMV infection in HIV-infected patients.


METHODS
Plasma samples were collected from 28 CMV-seropositive patients with advanced HIV-infection (CD4-cell count <200/microl) before commencement of antiretroviral therapy. Sensitivity, specificity, and area under receiver operating characteristic curve for the selected acute phase protein assays (haptoglobin, fibronectin, high-sensitivity C-reactive protein (hs-CRP), human interleukin-6, serum amyloid A (SAA), and human lipopolysacharide binding protein) were compared with results of a CMV-specific PCR assay.


RESULTS
CMV viremia was detectable in 8/28 patients. Levels of SAA correlated well with those of hs-CRP (r' = 0.439, P = 0.019 (Spearman rank correlation)). Levels of SAA >3 mg/L discriminated with 100% sensitivity and 40% specificity between HIV-infected patients with and without active CMV infection. Sensitivity of fibronectin was 100% and specificity 15% at a threshold-value corresponding with the lower limit of normal values as defined by the manufacturer of the assay (>29 mg/dL). Levels of the other acute phase proteins evaluated did not correlate with detection of CMV-DNA in plasma.


CONCLUSIONS
Increased levels of SAA indicate sensitively an inflammatory response to active CMV infection. Use of a CMV-specific virological assay is required to confirm the specificity of a high SAA-level but may be limited to samples with high SAA-levels. Hence, screening for increased levels of SAA in patients with advanced HIV-infection may allow early identification of active CMV infection.
Medical University of Vienna, Department of Medicine I, Währinger Gürtel 18-20, A-1090 Vienna, Austria. christoph.steininger@meduniwien.ac.at
Christoph
C
Steininger
W
W
Graninger
A
A
Zoufaly
B
B
Zöllner
H-H
HH
Feucht
M
M
Kundi
I
I
Stahmer
H-J
HJ
Stellbrink
J
J
van Lunzen
D000328:Adult; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology; D015331:Cohort Studies; D003587:Cytomegalovirus / Q000378:metabolism; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000378:metabolism / Q000821:virology*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000378:metabolism / Q000821:virology*; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011446:Prospective Studies; D012372:ROC Curve; D000685:Serum Amyloid A Protein / Q000378:metabolism*
D000685:Serum Amyloid A Protein