Reply

We thank Gentile et al. [1], who expressed interest in our recent work [2]. They reported that in a small prospective study of 23 human immunodeficiency virus (HIV)-infected subjects with lymphoma, pp150 antigenemia had a poor sensitivity (43%) compared with pp65 antigenemia (sensitivity, 86%) and viremia (sensitivity, 57%) in detecting cytomegalovirus (CMV) disease. As pointed out by Gentile et al., it is difficult to compare the results of the 2 studies, since different methodologies (monoclonal antibodies vs. reverse transcription-polymerase chain reaction [RT-PCR]) were used to detect pp150. However, it is interesting to note that we detected pp150 CMV mRNA in peripheral blood leukocytes from 50.0% of HIV-infected patients with CMV disease and 16.7% of subjects without CMV disease. These numbers are similar to those of Gentile et al., who detected pp150 antigenemia in 43% and 19% of HIV-infected subjects with and without CMV disease, respectively. We found an association between the detection of pp150 mRNA in leukocytes and the presence of CMV disease, but, similar to findings in the study by Gentile et al., such an association was not found in a multivariate analysis after controlling for the viral DNA load in leukocytes. Furthermore, levels of pp150 CMV transcripts (as determined semiquantitatively in our study) were not associated with CMV disease. In both studies and as reported by others [3–5], detection of the late CMV pp150 mRNA or protein was highly specific for the diagnosis of CMV disease. As mentioned in our study, similar specificity can be achieved by performing a CMV PCR test on plasma, which is more convenient for assessing the circulating virus load on leukocytes than RT-PCR. Gentile et al. concluded by suggesting that the clinical value of pp150 antigenemia is inferior to that of pp65 antigenemia for monitoring patients at high risk for CMV disease. This might be the case, but we did not make such a comparison in our study. Of interest, Gerna et al. [6] recently reported that detection of another late CMV transcript (pp67) by nucleic acid sequence-based amplification (NASBA) was less sensitive but slightly more specific than pp65 antigenemia for the detection of CMV infection (as defined as a positive CMV PCR test on leukocytes) in solid organ and bone marrow transplant recipients. However, other groups have reported a higher sensitivity of NASBA over pp65 antigenemia for the detection of CMV infection in renal-allograft recipients [7]. Prospective evaluations of these different methodologies still need to be performed, using standardized predetermined end points for each different group of immunocompromised subjects.

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