Seroepidemiology of cytomegalovirus in patients with advanced HIV disease: influence on disease expression and survival.

To determine the prevalence and effect of cytomegalovirus (CMV) co-infection on clinical outcome, the seroepidemiology of CMV was examined in 196 demographically diverse patients with advanced HIV disease. Thirty-six (18.4%) were seronegative for CMV; 31 of these 36 (86.1%) were both non-black and non-homosexual. Invasive CMV disease developed in 41 of 160 (25.6%) seropositive patients and 0 of 36 (0%) seronegative patients (p = 0.00015). Among seropositive patients, the frequency of CMV disease varied markedly according to risk group for acquisition of HIV infection. CMV disease occurred in 26 of 73 (35.6%) homosexual men and 11 of 33 (33.3%) heterosexuals, but only 2 of 47 (4.3%) injection drug users. Sexual exposure as the only risk factor for the acquisition of HIV was a highly significant independent risk factor for invasive CMV when other covariables were considered in a proportional hazards model (risk ratio 5.4, p = 0.0019). The cumulative proportion of all seropositive patients developing CMV disease after 3 years was 31%. CMV serologic status had no effect on occurrence of AIDS-related illnesses other than CMV disease and no effect on survival. Risk for the development of CMV disease varies substantially among different groups of patients with advanced HIV disease and can be assessed using serologic and demographic criteria. The results of this study may be used to influence clinical management and help target prophylactic interventions for CMV disease to high-risk individuals.