3rd Conference on Retroviruses and Opportunistic Infections


Washington, DC - January 28-February 1, 1996

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DETECTION OF CYTOMEGALOVIRUS IN SAMPLES FROM PATIENTS ENROLLED IN ACTG 204 / GLAXO WELLCOME 123-014.

Conf Retroviruses Opportunistic Infect 1996 Jan 28-Feb 1; 3rd:54 (abstract no. 10)

Griffiths PD, Feinberg J
Royal Free Hospital, London, UK.

We report the longitudinal relationship between the detection of CMV DNA in blood and urine by PCR, and the development of CMV disease in patients with advanced HIV disease enrolled in a study comparing valaciclovir and acyclovir for CMV prophylaxis.

PATIENTS AND SAMPLES: 310 patients were prospectively sampled. Urine and whole blood were collected at weeks O, 4, 8, and every 8 weeks thereafter. Urine was tested without processing; DNA was extracted from whole blood by ion exchange chromatography. The non-nested PCR method using gB primers has been previously described (1). Baseline results have been previously described (2).

RESULTS: Overall 20% of patients developed CMV disease; predominantly retinitis (17%). The relative risk of disease was 0.465 (0.248-0.872, 95% CI) for PCR positivity in blood, and 0.543 (0.311-0.948, 95% CI) for PCR positivity in urine. The positive predictive value of PCR was 0.26 for blood and 0.25 for urine. The sensitivity was 0.63 for blood and 0.75 for urine. Patients randomised to receive valaciclovir had a lower disease rate than those who received acyclovir. The largest difference in disease rates observed was between patients receiving valaciclovir and acyclovir who were PCR positive in blood at study onset (6% vs 36%).

CONCLUSION: We conclude that active infection occurs earlier than previously thought so that consideration should be given to using CMV prophylaxis at an earlier stage in HIV disease progression. Patients who were initially PCR positive in blood or urine were at highest risk of developing disease, and the effect of valaciclovir in reducing disease was most striking in patients who were viremic at study onset. 1. Kidd et al (1993). Transplantation. 1993 Oct;56(4):867-71 2. Griffiths et al (1995); Proceedings of the 35th ICAAC; San Francisco.

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