LETTER
How Useful Are Cytomegalovirus Cultures in Patients with HIV Infection?
Michael P. Dube and
Fred R. Sattler
1 August 1993 | Volume 119 Issue 3 | Pages 247-249
TO THE EDITOR:
We disagree that CMV blood cultures have no clinical utility and interpret the results of Zurlo and colleagues [1] to suggest that positive cultures have an important prognostic value. That 35% of their patients with viremia developed end-organ disease, after a mean of 84.1 days, suggests that these patients should be closely monitored in the ensuing months. A prospective study by Salmon and colleagues (2; not cited by Zurlo and colleagues) supports this approach. Fifty percent of patients with CMV viremia (14 of 28) followed for at least 6 months developed end-organ involvement compared with only 9.3% (4 of 43) of patients without viremia at the initial diagnosis of the acquired immunodeficiency syndrome (P < 0.001). More than 60% of patients with CMV retinitis had viremia (94% in Salmon and colleagues' study [2]), irrespective of ocular symptoms. Thus, detection of CMV viremia during the evaluation of fever should prompt a thorough evaluation and close monitoring to detect early CMV end-organ disease.
1. Zurlo JJ, O'Neill D, Polis MA, Manischewitz J, Yarchoan R, Baseler M, et al. Lack of clinical utility of cytomegalovirus blood and urine cultures in patients with HIV infection. Ann Intern Med. 1993; 118: 12-7.
2. Salmon D, Lacassin F, Harzic M, Leport C, Perronne C, Bricaire F, et al. Predictive value of cytomegalovirus viraemia for the occurrence of CMV organ involvement in AIDS. J Med Virol. 1990; 32: 160-3.
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