Diagnostic Utility of Quantitative Plasma Cytomegalovirus DNA PCR for Cytomegalovirus End-Organ Diseases in Patients With HIV-1 Infection

Objective:To investigate the diagnostic value of quantitative plasma cytomegalovirus (CMV)-DNA polymerase chain reaction (PCR) for CMV end-organ diseases (CMV-EOD) in patients with HIV-1 infection.Design:Single-center cross-sectional study.Methods:The study subjects were HIV-1-infected patients with CD4 200 per microliter, who had undergone ophthalmologic examination with plasma CMV-DNA PCR measured within 7 days. CMV retinitis and other CMV-EOD were diagnosed according to the ACTG criteria. PCR value was converted into the WHO international standard.Results:CMV retinitis and all CMV-EOD were diagnosed in 23 (5%) and 37 (8%) of the 461 study patients, respectively. CMV-DNA was undetectable (<185 IU/mL) in 2 patients with CMV retinitis and 1 with encephalitis. The area under the receiver operating characteristic curve of CMV-DNA for CMV retinitis and all CMV-EOD were 0.80 [95% confidence interval (CI): 0.71 to 0.89] and 0.82 (0.75 to 0.89), respectively. The sensitivity, specificity, positive predictive value, and negative predictive value for each cutoff value of CMV-DNA were as follows: for CMV retinitis, 10,086 IU/mL: 26.1%, 94.1%, 18.8%, 96%; 2946 IU/mL; 56.5%, 86.8%, 18.3%, 97.4%; 959 IU/mL; 60.9%, 78.1%, 12.7%, 97.4%; detectable CMV-DNA (185 IU/mL): 91.3%, 48.2%, 8.5%, 99.1%; for all CMV-EOD: 10,086 IU/mL: 32.4%, 95.3%, 37.5%, 94.2%; 2946 IU/mL; 54.1%, 88%, 28.2%, 95.6%; 959 IU/mL; 62.2%, 79.5%, 20.9%, 96%; detectable CMV-DNA; 91.9%, 49.5%, 13.7%, 98.6%.Conclusions:Plasma CMV-DNA PCR has a high diagnostic value for both CMV retinitis and all CMV-EOD in patients with advanced HIV-1 infection. A cutoff value of CMV-DNA 10,086 IU/mL and 2946 IU/mL yields high specificity, whereas undetectable CMV-DNA load (<185 IU/mL) likely rules out CMV-EOD.