ABSTRACT
The purpose of this study was to determine the sensitivity and specificity of three different methods of cytomegalovirus (CMV) detection for AIDS patients at risk for CMV retinitis. Patients with CD4(+) counts of <100/microl and negative baseline screening eye examinations were tested for CMV infection by (i) pp65 antigenemia expression in leukocytes, (ii) the Digene Hybrid Capture CMV DNA System, and (iii) the Roche Amplicor Qualitative PCR Test. The incidence of CMV retinitis in our study of 296 patients at the Medical Center of Louisiana-New Orleans HIV Outpatient Clinic was 7. 2 per 100 person-years (a total of 20 episodes in 18 patients from April 1997 to February 1999). Receiver operating characteristic curves were calculated for each assay to determine optimal cutoff points which maximized the sensitivity and specificity of each assay. The sensitivities of the assays compared to the eye examinations were 80% for the pp65 antigenemia assay (cutoff, >0 cell per 1.5 x 10(5) leukocytes), 85% for the Digene assay (cutoff, 1,400 genome copies/ml of whole blood), and 60% for the Amplicor assay. The specificities of the assays were 84, 84, and 87%, respectively. The Digene assay with a cutoff of >/=1,400 genome copies/ml gave optimal sensitivity and specificity and was found to have predictive values equal to those of the more technically cumbersome antigenemia assay.
Subject(s)
AIDS-Related Opportunistic Infections/diagnosis , Cytomegalovirus Retinitis/diagnosis , Cytomegalovirus/isolation & purification , DNA, Viral/analysis , Phosphoproteins/blood , Viral Matrix Proteins/blood , AIDS-Related Opportunistic Infections/virology , Adult , Cytomegalovirus/genetics , Cytomegalovirus Retinitis/virology , DNA, Viral/blood , Female , Humans , Male , Middle Aged , Polymerase Chain Reaction/methods , ROC Curve , Reagent Kits, Diagnostic , Sensitivity and SpecificitySubject(s)
AIDS-Related Opportunistic Infections/drug therapy , Antiviral Agents/therapeutic use , Cytomegalovirus Infections/drug therapy , Ganciclovir/therapeutic use , HIV Infections/complications , Thionucleotides/therapeutic use , Antiviral Agents/administration & dosage , CD4 Lymphocyte Count , Ganciclovir/administration & dosage , HIV Infections/drug therapy , Humans , Practice Guidelines as Topic , Thionucleotides/administration & dosageABSTRACT
The purpose of the study was to determine the seroprevalence of human T-lymphotropic virus types I and II (HTLV-I and HTLV-II) infections in an outpatient clinic population of human immunodeficiency virus (HIV)-1 infected persons as well as to identify the demographic and clinical characteristics and laboratory results associated with HTLV-I/II infections. During 1993-1995, 854 patients were tested for HTLV-I/II infection on entry into the clinic, of whom 25 were infected with HTLV-I and 35 with HTLV-II. Multivariate analysis revealed that patients with coinfections were more likely to be black, aged over 35 years, and have a history of injection drug use. HIV-1/HTLV-I coinfections were associated with higher median CD8 counts on entry (p < 0.05), and HIV-1/HTLV-II coinfections were associated with higher median percent CD4 counts (p < 0.05) compared with patients infected with HIV only. Coinfection was not associated with an increased diagnosis of AIDS. These findings indicate that HIV-1/HTLV-I/II coinfections are frequently diagnosed and are associated with unique immune phenotypes. Given the lack of information regarding the influence of dual infection on clinical status, differentiation of HTLV-I from HTLV-II infections may be important in understanding the clinical significance of retroviral coinfections.
