Quantitative cytomegalovirus (CMV) antigenaemia during antiviral treatment of AIDS-related CMV disease

In order to assess the value of quantitative measurement of cytomegalovirus (CMV) antigenaemia as a marker for the guidance of antiviral chemotherapy in the AIDS setting, 33 patients with CMV complications and showing at least 20 pp65-positive polymorphonuclear leucocytes per 2 x 10(5) cells, received either ganciclovir or foscarnet as induction and maintenance therapy. Antigenaemia was assessed every 1-4 weeks. During acute-phase antiviral therapy, a significant decrease of CMV antigenaemia (>50% of pretreatment levels) paralleled clinical improvement in 2-7 weeks in 32 of 33 subjects. In ten of 24 evaluable patients followed up during a further 4-12 months, disease relapses occurred concurrently with an increase of CMV antigenaemia in seven cases, while three cases of relapsing retinitis did not show a significant increase in antigenaemia. All patients with recurrent disease had a favourable response to further treatment, including halted clinical progression and significant decrease in antigenaemia. In HIV-related CMV disease, periodic monitoring of quantitative CMV antigenaemia proves useful in evaluating response to antivirals, in guiding therapeutic management and in predicting disease relapses.