Cytomegalovirus co-infection in patients with HIV/AIDS in north India

Background & objectives: Cytomegalovirus (CMV) is a frequent opportunistic infection in immunocompromised individuals particularly those receiving organ transplants and harbouring HIV infection. The classical CMV syndrome may be seen in only a small percentage of patients and tissue diagnosis is cumbersome, costly and requires hospitalization. Hence there is an urgent need to establish accurate and early diagnosis for proper institution of therapy. An attempt was made to detect active CMV co-infection in patients with HIV/AIDS using three assays and the positivity rates in the 2 groups compared. Methods: In the present study, we used a highly sensitive polymerase chain reaction (PCR) for immediate early gene of CMV, pp(65) antigenaemia assay and IgM ELISA assay to detect the presence of CMV co-infection in 37 patients with AIDS and 32 healthy HIV seropositives. Thirty healthy laboratory workers served as normal controls. Results: Of the 37 patients with AIDS, 12 (32.4%) showed a positive reaction by PCR and only 4 patients were positive by the antigenaemia assay. Of the 32 HIV seropositives, only one was positive by PCR (31%), and all were negative for antigen assay. None of the controls showed positivity by any of the tests. The difference in PCR positivity rates between HIV seropositives and patients with AIDS was significant (P<01). IgM antibodies were positive in four (10.3%) AIDS patients and only one (3%) HIV seropositive, the difference was insignificant. The difference in antigen positivity between HIV seropositives and AIDS patients was also insignificant. Interpretation & conclusion: CMV appears to be an important co-infection in patients with AIDS in India and PCR is a powerful tool for detection of CMV in blood and is superior to the antigenaemia assay. PCR can be performed with a small volume of blood avoiding any invasive procedure, and can provide quick information for timely institution of therapy.