Cytomegalovirus infection in the acquired immunodeficiency syndrome. Clinical and autopsy findings.

The clinical and autopsy findings of cytomegalovirus (CMV) infection in patients with the acquired immunodeficiency syndrome (AIDS) are reviewed. Of 164 patients, 81 had evidence of CMV infection at autopsy, but organ failure leading to patient demise from CMV occurred in only 17. Demographic differences between patients with AIDS with and without CMV were minimal. Cytomegalovirus was never the sole diagnostic criterion for AIDS in any patient but was always accompanied by at least one other opportunistic infection or neoplasm. The total clinical course did not significantly differ between the two groups, but the length of final hospitalization of patients with CMV was much longer. Therapy for CMV prolonged the clinical course in some cases but did not eliminate the infection or prevent death from CMV. At autopsy the most common sites of involvement were adrenal (75%), pulmonary (58%), gastrointestinal (30%), central nervous system (20%), and ocular (10%). Most patients (62%) had multiple sites of involvement. Gross pathologic findings were frequent but often subtle. Microscopic changes accompanying CMV inclusions were variable and usually limited in extent.