Lessons from the natural history of cytomegalovirus.

Important note: Information in this article was accurate in 1997. The state of the art may have changed since the publication date.

Lessons from the natural history of cytomegalovirus.

AIDS. 1996 Nov;10 Suppl 1:S37-41. Unique Identifier : AIDSLINE MED/97125603
Bowen EF; Griffiths PD; Davey CC; Emery VC; Johnson MA; Department of Virology, Royal Free Hospital, London, UK.

Abstract: BACKGROUND: More than 90% of patients with HIV have been infected at some time with cytomegalovirus (CMV) and up to 40% of those with advanced HIV will develop CMV disease. The incidence of CMV disease is increasing but the prognosis for the patient remains poor. MONITORING FOR CMV: It is therefore important to monitor patients with low CD4+ counts in order to identify those most at risk of developing CMV disease and to treat them before the disease becomes established. Polymerase chain reaction (PCR) is probably the most effective and sensitive method of detecting CMV and a positive result is predictive for development of CMV disease; more than 80% of patients with CMV retinitis are CMV PCR-positive at the time of diagnosis. PCR can also detect the presence of CMV up to 14 months before the development of retinitis. TREATMENT OF CMV RETINITIS: In patients with detectable CMV, but no evidence of active infection, pre-emptive treatment with ganciclovir or valaciclovir has been shown to reduce the risk of developing retinitis in these high-risk patients. Such oral therapy, which is generally better tolerated than intravenous therapy and results in a better quality of life for the patient, is likely to be more effective at this stage whilst viral loads are low. CONCLUSIONS: CMV PCR can be used to prospectively monitor patients in order to identify those most at risk of developing CMV retinitis. If CMV infection is diagnosed early, while viral loads are still low, pre-emptive oral therapy can be instituted which will reduce the chances of developing retinitis in those patients most at risk.

Keywords: *AIDS-Related Opportunistic Infections/DIAGNOSIS *Cytomegalovirus Infections/COMPLICATIONS
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