Cytomegalovirus (CMV) Viremia and the CD4+ Lymphocyte Count as Predictors of CMV Disease in Patients Infected with Human Immunodeficiency Virus

Abstract

We screened 192 patients infected with human immunodeficiency virus (HIV) to examine the relation between CD4⁺ lymphocyte counts and cytomegalovirus (CMV) viremia and the occurrence of CMV disease and subsequent duration of survival. When we stratified the viremic patients by CD4⁺ lymphocyte counts, the proportions were as follows: 150/mm³, 1 (1.5%) of 62. After a mean follow-up period of 8.5 months, 21 (11%) of 192 patients developed CMV disease. The probability of developing CMV disease at 6 months was 13% when the CD4⁺ lymphocyte count was 100/mm³; this probability was 46% for viremic patients and 1% for nonviremic patients. In a multivariate analysis, CMV viremia was independently prognostic of CMV disease (relative risk, 22.03; 95% confidence interval, 6.49–78.97; P < .001), whereas a CD4⁺ lymphocyte count of 3 was not (P = .26). These results support the value of CMV viremia for predicting which HIV-infected patients are at risk of developing CMV disease and should therefore receive primary prophylaxis.