Detection of Human Cytomegalovirus Retinitis and Monitoring of Ganciclovir Treatment Using Conjunctival Swab with Polymerase Chain Reaction in AIDS Patients

Abstract

This report studies the accuracy of conjunctival swab polymerase chain reaction (CS-PCR) for the diagnosis of human cytomegalovirus retinitis (HCMV) in AIDS patients. PCR and virus culture were used for the detection of HCMV in conjunctival swab, serum, and urine specimens from 38 AIDS patients between April 1996 and April 1998. The clinical utility of the identification of HCMV retinitis by these 6 different methods was demonstrated by their prediction power to estimate AIDS patients at risk of contracting HCMV retinitis. The sensitivity, specificity, positive predictive value, and negative predictive value of CS-PCR for the detection of HCMV retinitis were 91.5%, 80.9%, 60.8%, and 92.7%, respectively; for serum PCR were 74.3%, 81.7%, 57.2%, and 90.3%; for urine PCR were 100%, 17.3%, 20.4%, and 100%; for conjunctival swab culture were 22.7%, 100%, 100%, and 86%; for serum culture were 27.3%, 98.1%, 75%, and 86.4%; and for urine culture were 90.9%, 44.2%, 25.6%, and 95.8%.

Apoptosis of Human Retina and Retinal Pigment Cells Induced by Human Cytomegalovirus Infection

“…If HCMV in retina transmits through cell-cell contacts, focal infection would be the major pattern and necrotizing retina would be limited to a small area. However, HCMV infection in retina causes large-scale cell death and tremendous visual dysfunction [6,7]. Clinical experience and laboratory evidences have shown the vital role of the cellular immune systems in controlling HCMV retinitis of AIDS patients [5,8].…”