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HIV related cytomegalovirus (CMV) disease results from reactivation of latent infection when the CD4 count falls below 100 cells ×106/l. Before the introduction of highly active antiretroviral therapy (HAART) up to 40% of HIV infected patients developed CMV disease, predominantly retinitis. Early diagnosis of retinitis may result in a better response to therapy and reduced loss of vision. As retinitis is often asymptomatic in the early stages, other methods of identifying individuals at risk are required.
CMV viraemia precedes disease so the detection of CMV viraemia identifies individuals at highest risk. Cell culture based methods of detection have now been superseded by polymerase chain reaction (PCR) and pp65 antigenaemia assays. The application of quantitative techniques has shown that elevated CMV load increases the risk of CMV disease in congenital infection1 and following renal,2 liver,3 and bone marrow4 transplantation.Sex Transm Inf 2000;76:342–344
Identification of patients at risk of CMV disease
The detection of CMV reactivation by polymerase chain reaction (PCR) is a strong predictor of disease.5–7 CMV load is significantly higher in patients who develop disease and the risk of disease increases with increasing CMV load; high CMV load also correlates with decreased survival.5 Two large randomised controlled trials of CMV prophylaxis showed that CMV PCR positivity at baseline is a significant risk factor for CMV disease and is associated with an increased risk of death independent of CD4 count.8,9 In addition, CMV load has a stronger correlation with death than HIV load.10 Therefore, regular screening of patients with a CD4 count below …