555   Correlates of Change in CMV Viremia in Patients with Advanced HIV Infection Requiring Transfusion.

M. F. Para*¹, L. A. Kalish², A. C. Collier³, E. L. Murphy⁴, and W. L. Drew⁵for the Viral Activation Transfusion Study (VATS) Group⁶.
¹The Ohio State Univ., Columbus;²New England Res. Inst., Watertown, MA;³Univ. of Washington Sch. of Med., Seattle;⁴Univ. of California, San Francisco;⁵Univ. of California, Mt Zion Med. Ctr., San Francisco; and⁶Natl. Heart, Lung and Blood Inst., Bethesda, MD.

Background::Our objective was to examine the relationships of serially measured CMV viremia, HIV RNA, CD4⁺cell counts and clinical outcomes in late-stage HIV⁺patients receiving blood transfusions.

Methods:VATS was a randomized, double-blind trial comparing leukocyte-reduced to unfiltered red cell transfusions in HIV and CMV antibody-positive, anemic patients undergoing their first blood transfusion. Baseline and complete quarterly follow-up clinical and laboratory data from VATS subjects were retrospectively examined. Qualitative and quantitative PCR assays for plasma CMV DNA were performed using the Roche Amplicor CMV assay. The quantitative CMV assay had a lower limit of quantification of 400 copies/mL.

Results:The 511 VATS subjects had a median CD4⁺cell count of 15 cells/mm³and were followed for a median of 1 year. A quarter of them had a history of CMV disease and 110 (21.5%) had CMV viremia by the qualitative PCR assay at baseline. While no significant relationship was found between the changes in CMV viremia and the changes in HIV viral load, increasing CMV viremia was associated with a subsequent fall in Karnofsky score. Potent antiretroviral therapy led to a decrease in CMV viremia, but this was only noted after 90 days of therapy. CMV viremia was associated with a markedly increased risk of CMV disease (relative hazard = 5.78) even after adjusting for concomitantly measured HIV RNA and CD4⁺cell count.

Conclusions:In late-stage HIV-infected patients, CMV viremia is associated with a lower functional status and increased risk of CMV disease. Treatment with potent antiretroviral therapy leads to a suppression of CMV viremia, but this is delayed for several months.