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Lack of Clinical Utility of Cytomegalovirus Blood and Urine Cultures in Patients with HIV Infection

John J. Zurlo, MD; Donna O'Neill, RN; Michael A. Polis, MD; Jody Manischewitz, MS; Robert Yarchoan, MD; Michael Baseler, PhD; H. Clifford Lane, MD; and Henry Masur, MD
[+] Article, Author, and Disclosure Information

From the National Institute of Allergy and Infectious Diseases, the Warren Grant Magnuson Clinical Center, and the National Cancer Institute, National Institutes of Health; the Food and Drug Administration, Bethesda, Maryland; Program Resources, Inc./Dyncorp, Frederick, Maryland. Requests for Reprints: John J. Zurlo, MD, P.O. Box 850, Hershey Medical Center, Hershey, PA 17033. Grant Support: In part by the National Cancer Institute, Department of Health and Human Services, under contract N01-CO-74102 with Program Resources, Incorporated/Dyncorp.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1993;118(1):12-17. doi:10.7326/0003-4819-118-1-199301010-00003
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Objective: To determine the clinical significance of cytomegalovirus (CMV) blood and urine cultures in patients with human immunodeficiency virus (HIV) infection.

Design: Inception cohort of patients with HIV infection and CMV culture data.

Setting: Government referral-based research hospital.

Patients: A total of 322 HIV-infected patients who had a CMV blood culture and 293 HIV-infected patients who had a CMV urine culture within 7 days of a CD4 determination.

Measurements: Cytomegalovirus blood and urine culture results; circulating CD4 lymphocyte counts; pathologic or retinopathic findings of CMV disease.

Results: Nine of 26 patients (34.6%) with CMV viremia subsequently developed CMV end-organ disease compared with 11 of 74 (14.9%) patients without viremia, (difference, 19.7%; 95% CI, −0.3% to 39.7%). Fifteen of 47 patients (31.9%) with CMV viruria developed end-organ disease compared with 4 of 43 (9.3%) patients without viruria, (difference, 22.6%; CI, 6.7% to 38.5%). Cytomegalovirus culture positivity had poor predictive value for the subsequent development of end-organ disease (35% for viremia and 28% for viruria). Further, patients with proven end-organ disease were often not viremic (45%), but most were viruric (88%). Cytomegalovirus viremia did not correlate with the presence of either fever or weight loss in this patient group. Both blood culture positivity and urine culture positivity varied inversely with the CD4 count (P = 0.0001 for both associations).

Conclusions: The likelihood that a blood or urine culture will be positive in a patient with HIV infection correlates better with immunologic status than with current or future clinical status. Although the absence of CMV viruria may suggest that CMV disease is not present, CMV blood and urine cultures have poor diagnostic and predictive value and therefore should be used primarily for research purposes or drug susceptibility testing and not for making clinical decisions.


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Figure 1.
Cytomegalovirus (CMV) end-organ disease according to CMV blood and urine culture results in human immunodeficiency virus-infected patients with CD4 counts ≤ 200/mm3 and without baseline CMV end-organ disease.nnnn

The percent of patients with end-organ disease who had a positive blood culture ( = 26), a negative blood culture ( = 74), or a positive urine culture ( = 47), or a negative urine culture ( = 43) for CMV is shown.

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Figure 3.
Time to development of cytomegalovirus (CMV) end-organ disease according to CMV blood and urine culture results among 25 patients free of CMV disease at the time of initial culture.333

Individuals are grouped according to CMV culture result. A separate analysis groups individuals according to CD4 count greater and less than 100/mm , independent of CMV culture result. Ten patients were blood-culture–positive; 15, blood-culture–negative; 17, urine-culture–positive; and 7, urine-culture–negative. Sixteen patients had CD4 cell counts ≤ 100/mm , and 9 patients had counts greater than 100/mm . Boxes represent mean ± SE.

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Figure 2.
Cytomegalovirus blood and urine culture results according to CD4 count.

Results are shown for 293 patients with cytomegalovirus blood and urine cultures done on the same day.

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