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The diagnostic value of polymerase chain reaction for cytomegalia virus in patients with HIV-infection.
Merl S; Emminger C; Karwat M; Spiegl F; Jager U; Eichenlaub D; Municipal
January 30, 1997
Int Conf AIDS. 1996 Jul 7-12;11(2):93 (abstract no. We.B.3213). Unique

In long term surviving patients with AIDS, CMV-disease becomes an increasing clinical problem. Findings at autopsy confirm clinicians suspicion, that CMV-disease exceeds far the known manifestations: retinitis and gastrointestinal tract involvement. The value of different diagnostic tests to confirm the disease is unclear. Objective: To evaluate the diagnostic value of polymerase chain reaction (PCR) for cytomegalia virus (CMV) in patients with HIV-infection. Methods: All the PCR tests for CMV performed in our patients admitted for HIV related disease done in 1994 and 1995 were evaluated retrospectively. Clinical data were obtained from the patients records. CMV infection was diagnosed by endoscopic and/or histological procedures, by experienced ophtalmologists and by chest X-ray, clinical signs and therapeutic response after exclusion of other pulmonary diseases (CMV pneumonitis). The records were reviewed in all cases. Results: 54 patients were examined. In 10 cases there was a positive PCR for CMV, in 44 patients PCR was negative. In 8 of the 10 cases with positive result we were able to detect a clinically significant manifestation of CMV disease: There were 2 patients with colitis, 2 with encephalitis, 2 with pneumonitis combined with suspected generalized infection, one case of retinitis combined with anal ulcers and one case of retinitis combined with encephalitis (after exclusion of other cerebral complications). In 9 of the 44 PCR negative patients a clinical significant manifestation of CMV disease was detected. We found 2 cases of colitis, 2 of retinitis, 2 of pneumonitis, 2 of pneumonitis combined with esophagitis and 1 of retinitis combined with colitis. The sensitivity of PCR testing for CMV was calculated as 47%, the specifity as 94%. Conclusion: In our opinion the PCR testing for CMV is a useful method to exclude a clinically suspected CMV disease in cases where typical CMV manifestation (retinitis, gastrointestinal or cutaneous) cannot be diagnosed. On the other hand the CMV PCR is not a suitable method to screen patients for an acute CMV manifestation.

*Cytomegalovirus Infections/DIAGNOSIS *HIV Infections/COMPLICATIONS