Journal Article

Poor Predictive Value of Cytomegalovirus (CMV)— Specific T Cell Assays for the Development of CMV Retinitis in Patients with AIDS

Mark A. Jacobson, Qi Xuan Tan, Valerie Girling, C. Poon, Mark Van Natta, Douglas A. Jabs, Margaret Inokuma, Holden T. Maecker, Barry Bredt and Elizabeth Sinclair

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 46, issue 3, pages 458-466
Published in print February 2008 | ISSN: 1058-4838
Published online February 2008 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/525853
Poor Predictive Value of Cytomegalovirus (CMV)— Specific T Cell Assays for the Development of CMV Retinitis in Patients with AIDS

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Background.We examined the potential clinical utility of using a cytomegalovirus (CMV)–specific T cell immunoassay to determine the risk of developing new-onset CMV retinitis (CMVR) in patients with acquired immunodeficiency syndrome (AIDS).

Methods.CMV-specific T cell assays were performed by multiparameter flow cytometry using stored peripheral blood mononuclear cells that had been obtained in an observational study 2–6 months before new-onset CMVR was diagnosed in case patients (at a study visit during which a dilated ophthalmologic examination revealed no evidence of CMVR) and at the same study visit in control subjects (matched by absolute CD4+ T cell count at entry) who did not subsequently develop retinitis during 1–6 years of study follow-up.

Results.There were no significant differences in CMV-specific CD4+ or CD8+ T cell interferon-γ or interleukin-2 expression in peripheral blood mononuclear cells from case patients and control subjects. Although there were trends toward lower percentages and absolute numbers of CMV-specific, cytokine-expressing CD8+ T cells with a “late memory” phenotype (CD27-CD28-) as well as with an “early memory” phenotype (CD27+CD28+CD45RA+) in case patients than in control subjects, these differences were not statistically significant.

Conclusions.Many studies have reported that CMV-specific CD4+ and CD8+ T cell responses distinguish patients with active CMVR (i.e., who lack CMV-protective immunity) from those with inactive CMVR after immune restoration by antiretroviral treatment (i.e., who have CMV-protective immunity). However, the multiple CMV-specific immune responses we measured do not appear to have clinical utility for predicting the risk for patients with AIDS of developing new-onset CMVR with sufficient accuracy to be used in guiding therapeutic management.

Journal Article.  5739 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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