Standardization of Antigenemia and qPCR Cut-off Values in Whole Blood for the Detection of Cytomegalovirus Disease in HIV Patients

Carstensen, Suzana; Raboni, Sonia Mara; França, João Cesar Beenke; Teixeira, Francine

doi:10.1590/0037-8682-0457-2018

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Sumário

Short Communication • Rev. Soc. Bras. Med. Trop. 52 • 2019 • https://doi.org/10.1590/0037-8682-0457-2018 copy

Standardization of Antigenemia and qPCR Cut-off Values in Whole Blood for the Detection of Cytomegalovirus Disease in HIV Patients

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

INTRODUCTION:

We defined the cut-off values of the antigenemia and cytomegalovirus (CMV) DNA tests in HIV/AIDS patients to identify CMV disease.

METHODS:

A total of 97 samples from 68 patients with and without CMV disease were analyzed by viral DNA detection and antigenemia assay.

RESULTS:

Qualitative and quantitative results significantly differed between assays. The cut-off values for the antigenemia and qPCR assays were 1.5 positive cells/200,000 leukocytes and 3.715 log/mL, respectively.

CONCLUSIONS:

Antigenemia and qPCR are suitable for monitoring CMV disease in HIV patients, however, the threshold values should be determined within the centers where the patients are monitored.

Keywords:
AIDS; Cytomegalovirus; Real-time PCR; pp65 antigenemia

Features	Patients samples without CMV disease	Patients samples with CMV disease	P value
	N = 84 (86,6%)	N = 13 (13,4%)
Current CD4+ T-cell (cells/mm ^³ )	90 (30-201)	17 (16-207)	0.047
Median ±IQR
Current HIV viral load (log/mL)	4,01 (1,82)	5,15 (0,77)	0.027
Mean ±SD
Time until HIV diagnosis (days)	1337 (49,5-5362)	47 (15,5-1789)	0.010
Median ±IQR
Time until HIV diagnosis and onset of CMV (days)	NA	47 (9-1509)	NA
Median ±IQR
Time to use ART before hospitalization (days)	135 (46-1705)	24 (14,5-26)	0.002
Median ±IQR

Category	Without CMV	With CMV	P value
	disease	disease
	n=84 (%)	n=13 (%)
pp65 Antigenemia			<0.0001
Positive	16 (19,1)	10 (76,9)
Negative	68 (80,9)	3 (23,1)
qPCR CMV			<0.0001
Detected	32 (38,1)	13 (100)
Not detected	52 (61,9)	0 ( 0 )
pp65 Antigenemia			<0.0001
positive
cells/200.000	2,3 (7,5)	55 (117)
Mean (SD)	0 ( 0 )	12 (1-66)
Median ±IQR
qPCR CMV
log/mL	1,1 (1,6)	3,9 (0,8)	<0.0001
Mean (SD)

	Antigenemia (CI 95%)	qPCR (CI 95%)
Sensitivity	77% (45-93%)	100% (71-100%)
Specificity	80% (70-88%)	61,9% (50-72%)
Positive predictive value (PPV)	38% (20-59%)	28% (16-44%)
Negative predictive value (NPV)	95% (87-98%)	100% (91-100%)
Likelihood Ratio (LR+)	4 (2.3-6.8)	2.62 (1.99-3.44)
Likelihood Ratio (LR-)	0.28 (0.1-0.77)	0
Prevalence (PPV)
2%	7%	5%
5%	17%	12%
10%	30%	22%
15%	41%	31%
Prevalence (NPV)
2%	99%	100%
5%	98%
10%	96%
15%	95%

Sociedade Brasileira de Medicina Tropical - SBMT Sociedade Brasileira de Medicina Tropical - SBMT, Núcleo de Medicina Tropical UnB, Sala 43C 70904-970, E-mails: rsbmt@uftm.edu.br | artes.rsbmt@gmail.com | sbmt@sbmt.org.br , WhatsApp: SBMT (61) 9.9192-6496, WhatsApp: RSBMT (34) 9.9996-5807 - Brasília - DF - Brazil
E-mail: rsbmt@uftm.edu.br

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[1] Corresponding author: Sonia Mara Raboni. e-mail:sraboni@ufpr.br