Int Conf AIDS 1996 Jul 7-12; 11:218 (abstract no. Th.A.394) Bowen EF, Wilson PM, Davey C, Johnson MA, Griffiths PD; Virology Department, Royal Free Hospital, London, UK. Fax: 0171 830 2854.
Objectives. We have previously shown how quickly asymptomatic peripheral cytomegalovirus (CMV) retinitis spreads to become sight threatening if untreated (Bowen et al. Lancet 1995, 346: 1671-1673). We know that 86% patients with retinitis are CMV PCR+ at diagnosis and therefore set out to evaluate the use of polymerase chain reaction and CMV load to prospectively identify patients most at risk of CMV retinitis. Methods. All HIV-positive patients presenting with constitutional symptoms and a CD4 count less than 50 cells/microliter were screened for CMV in blood by PCR every 3 months. All CMV PCR+ patients were then fully assessed by indirect ophthalmoscopy. Patients with no evidence of retinitis were subsequently followed monthly with CMV PCR and eye clinic review. Results. 18 patients were PCR+in the first 7 months of the study. 11 patients have developed CMV disease during follow-up, with a median time of follow-up of 2.75 months from initial PCR+ result. None of the 7 remaining PCR+ patients, with a median follow-up of 2 months, have developed CMV disease. 62 patients remain PCR- and free of CMV disease with a median follow-up of 5 months. 8 patients developed peripheral retinitis with normal visual acuity, 3 patients developed CMV disease of the gastrointestinal tract, one of whom was found to have peripheral retinitis 3 months after ganciclovir therapy for CMV oesophageal ulceration. The relative risk of developing CMV disease after a PCR + result was 6.8 (95% CI 3.44-13.48). All 11 patients who developed disease had increasing levels of CMV viral load up to the manifestation of disease. Full statistical analysis on the viral load results will be presented. Conclusions. CMV DNA detected in blood by PCR strongly correlates with the development of CMV disease. PCR may be used to screen patients at risk to diagnose retinitis before visual acuity is affected and therefore allow prompt and individualised therapy. Increasing CMV load also seems to be important in the pathogenesis of CMV disease and prospective monitoring of viral load may identify patients who would benefit from pre-emptive therapy. We are currently evaluating shorter courses of induction ganciclovir therapy in relation to viral load at diagnosis of retinitis.
Keywords: AEGIS, Cytomegalovirus Retinitis, Cytomegalovirus, Ganciclovir, Polymerase Chain Reaction, Cytomegalovirus Infections, Viral Load, CD4 Lymphocyte Count, Antiviral Agents, HIV Infections, Anti-HIV Agents, HIV Protease Inhibitors, Human, ICA11
