Cytomegalovirus: update

William L Drew MD, PhD and Jacob Lalezari MD, updated 6/02.

Cytomegalovirus (CMV) has been a major cause of morbidity and mortality in patients with AIDS. Epidemiologic studies indicated that through 1992 nearly half of HIV-infected patients eventually developed CMV end-organ disease including chorioretinitis, esophagitis, colitis, pneumonia, and central nervous system disease. With the advent of highly active antiretroviral treatment (HAART) there has been a dramatic decline in the occurrence of CMV disease in AIDS patients to approximately 5-10% of previous estimates. A diagnosis of CMV disease can be based on clinical evaluation (eg, CMV retinitis) but often requires tissue biopsy with histologic evidence of viral inclusions and inflammation (eg, CMV colitis). A positive CMV culture of blood, urine, or even biopsy tissue may only reflect active infection rather than true end-organ disease. Detection of CMV antigens or nucleic acids in tissue specimens are alternative, but less conclusive, methods for making a diagnosis of CMV disease.

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