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Bhugra A, Khodare A, Agarwal R, Pamecha V, Gupta E. Role of cytomegalovirus specific cell-mediated immunity in the monitoring of cytomegalovirus infection among living donor liver transplantation adult recipients: A single-center experience. Transpl Infect Dis 2023; 25:e14011. [PMID: 36602403 DOI: 10.1111/tid.14011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/11/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cytomegalovirus (CMV) is one of the most common post-transplant viral infections causing significant morbidity and occasional mortality. Limited literature on the potential role of pre-transplant CMV-specific cell-mediated immunity (CMV-CMI) is available. This study aimed to evaluate the clinical utility of pre-transplant CMV-CMI monitoring in the occurrence of post-transplant CMV infection. METHODS This was a prospective, observational study where all adult CMV seropositive patients undergoing living donor liver transplantation at a tertiary care institute were enrolled. CMV-CMI was measured using QuantiFERON-CMV (Qiagen GmbH, Hilden, Germany) and interpreted as positive if the value was ≥0.2 IU/ml, 1-2 days prior to the transplant. Based on pre-transplant CMV-CMI, cases were classified into Group 1 (n = 13, 43.3%) (positive) and Group 2 (n = 17, 56.7%) (negative). CMV infection was defined as the detection of CMV-DNA > 2.7 log10 IU/ml in plasma specimens. RESULTS The mean age was 43 years with male (n = 29, 96.9%) predominance. Overall 40% of recipients developed post-transplant CMV infection, two (15.4%) in group 1 and 10 (58.8%) in group 2 (p-value = 0.016). Recipients in group 2 had 87% higher odds (odds ratio 0.13, confidence interval [CI] 95) of developing post-transplant CMV infection compared to group 1. The overall median duration of occurrence of post-transplant CMV infection was 26 days with the median viral load being 2.8 log10 IU/ml. The treatment duration was 13 days in group 1 and 28 days in group 2 (p = 0.003). Group 1 recipients showed rapid clearance of CMV-DNA within 7 days compared to group 2 in which it was 21 days (p = 0.004, CI 95). CONCLUSION Pre-transplant CMV-CMI may play a protective role against post-transplant CMV infection and can serve as an adjunct for pre-transplant risk stratification.
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Affiliation(s)
- Arjun Bhugra
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Arvind Khodare
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Reshu Agarwal
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Viniyendra Pamecha
- Department of Hepato-pancreato-biliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ekta Gupta
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India
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2
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Jorgenson MR, Descourouez JL, Leverson GE, Saddler CM, Smith JA, Garg N, Parajuli S, Mandelbrot DA, Odorico JS. A pilot study of an intensified ganciclovir dosing strategy for treatment of cytomegalovirus disease in kidney and/or pancreas transplant recipients. Clin Transplant 2021; 35:e14427. [PMID: 34263938 DOI: 10.1111/ctr.14427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/07/2021] [Accepted: 07/08/2021] [Indexed: 12/15/2022]
Abstract
PROBLEM Mathematical modeling suggests aggressive ganciclovir dosing in the first week of cytomegalovirus disease (CMV) treatment may improve response. This has not been evaluated clinically. METHODS Adult kidney and/or pancreas transplant recipients admitted with CMV (4/29/19-7/15/20) received IV ganciclovir(10 mg/kg Q12 h × 7 days) with step-down to standard-of-care (SOC) dosing thereafter (5 mg/kg Q12). A SOC cohort admitted before implementation of the dosing strategy (10/20/16-3/2/19) served as a comparator. PRIMARY OBJECTIVE rate of viral clearance (delta log CMV) at therapy day 7. SECONDARY OBJECTIVE safety/short term efficacy. RESULTS Fifty-four patients met inclusion criteria; 22 high-dose, 32 SOC. Demographics were similar with the exception of more women (45.4% vs. 15.6%,P = .03) and higher presenting viral-load in the high-dose group (log 6.0±.7 vs. log 5.2±1.2, P = .02). High-dose resulted in significantly greater response to therapy at day 7 (log -.92±.51 vs. log -.56±.79, P = .04). Change in WBC at day 7 was not different (-.49±1.92 vs. -.45±5.1, P = .97). Short-term clinical outcomes were similar between groups including mean hospital length-of-stay (P = .52), readmission rates (30 d: P = .38; 90 d: P = .5) and achievement of CMV viral-load less-than-lower-limit-of-quantification by day 90 (73% vs. 84%, P = .06). Rejection after CMV as well as graft/patient survival were similar between groups (P = .56, P > .99, P > .99). CONCLUSION A high-dose IV ganciclovir strategy results in improved viral clearance kinetics without safety concerns and similar short term clinical outcomes.
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Affiliation(s)
- Margaret R Jorgenson
- Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA
| | - Jillian L Descourouez
- Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA
| | - Glen E Leverson
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Christopher M Saddler
- Department of Medicine, Division of Infectious Diseases, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jeannina A Smith
- Department of Medicine, Division of Infectious Diseases, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Neetika Garg
- Department of Medicine, Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sandesh Parajuli
- Department of Medicine, Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Didier A Mandelbrot
- Department of Medicine, Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jon S Odorico
- Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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3
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Grønborg HL, Jespersen S, Egedal JH, Correia FG, Medina C, Krarup H, Hønge BL, Wejse C. Prevalence and clinical characteristics of CMV coinfection among HIV infected individuals in Guinea-Bissau: a cross-sectional study. Trop Med Int Health 2018; 23:896-904. [PMID: 29851192 DOI: 10.1111/tmi.13082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To describe the prevalence of CMV in a cohort of HIV infected individuals in Guinea-Bissau, West Africa and to evaluate differences in patients' clinical characteristics associated with their CMV status. METHODS Newly diagnosed HIV infected adults were invited to participate in this cross-sectional study, from May until December 2015. Enrolled patients were interviewed and underwent a full physical examination focusing on CMV disease manifestations. Blood samples were analysed for CMV serology, QuantiFERON-CMV response and CMV DNA. Mortality follow-up were registered for one year after inclusion. RESULTS In total, 180 patients were enrolled. Anti-CMV IgG positivity was found in 100% (138/138) and 2.8% (4/138) were anti-CMV IgM positive. A positive QuantiFERON-CMV response was found in 85.7% (60/70) of the patients and 60.6% (83/137) had CMV viraemia. QuantiFERON-CMV response and detectable CMV DNA were associated with lower CD4 cell count, older age and upper gastrointestinal complaints. During one year of follow-up, the IRR for death among CMV DNA positive patients was 1.5 (P = 0.5). CONCLUSIONS CMV coinfection was detected among all enrolled patients and CMV viraemia was highly prevalent. Only age and upper gastrointestinal complaints were associated with the patients' CMV status.
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Affiliation(s)
- Helene L Grønborg
- GloHAU, Department of Public Health, Aarhus University, Aarhus, Denmark.,Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - Sanne Jespersen
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.,Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | | | - Faustino G Correia
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.,National HIV Programme, Ministry of Health, Bissau, Guinea-Bissau
| | - Candida Medina
- National HIV Programme, Ministry of Health, Bissau, Guinea-Bissau
| | - Henrik Krarup
- Section of Molecular Diagnostics, Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Bo L Hønge
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.,National HIV Programme, Ministry of Health, Bissau, Guinea-Bissau.,Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Wejse
- GloHAU, Department of Public Health, Aarhus University, Aarhus, Denmark.,Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.,Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
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4
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Serrano-Alonso M, Guillen-Grima F, Martin-Moreno P, Rabago G, Manrique J, Garcia-del-Barrio M, Reina G, Torre-Cisneros J, Fernandez-Alonso M, Herrero J. Reduction in mortality associated with secondary cytomegalovirus prophylaxis after solid organ transplantation. Transpl Infect Dis 2018; 20:e12873. [DOI: 10.1111/tid.12873] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/02/2018] [Accepted: 01/14/2018] [Indexed: 01/06/2023]
Affiliation(s)
| | - F. Guillen-Grima
- Preventive Medicine Department; Clínica Universidad de Navarra; Pamplona Spain
- Department of Health Sciences; Public University of Navarra; Pamplona Spain
- Navarra's Health Research Institute (IdiSNA); Pamplona Spain
| | - P. Martin-Moreno
- Navarra's Health Research Institute (IdiSNA); Pamplona Spain
- Nephrology Department; Clínica Universidad de Navarra; Pamplona Spain
| | - G. Rabago
- Cardiac Surgery Department; Clínica Universidad de Navarra; Pamplona Spain
| | - J. Manrique
- Navarra's Health Research Institute (IdiSNA); Pamplona Spain
- Nephrology Department; Complejo Hospitalario de Navarra; Pamplona Spain
| | | | - G. Reina
- Navarra's Health Research Institute (IdiSNA); Pamplona Spain
- Microbiology Department; Clínica Universidad de Navarra; Pamplona Spain
| | - J. Torre-Cisneros
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC); Reina Sofía University Hospital; University of Cordoba; Cordoba Spain
| | - M. Fernandez-Alonso
- Navarra's Health Research Institute (IdiSNA); Pamplona Spain
- Microbiology Department; Clínica Universidad de Navarra; Pamplona Spain
| | - J.I. Herrero
- Navarra's Health Research Institute (IdiSNA); Pamplona Spain
- Liver Unit; Clínica Universidad de Navarra; Pamplona Spain
- Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBERehd); Madrid Spain
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5
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Puttarajappa CM, Hariharan S, Smith KJ. A Markov Analysis of Screening for Late-Onset Cytomegalovirus Disease in Cytomegalovirus High-Risk Kidney Transplant Recipients. Clin J Am Soc Nephrol 2018; 13:290-298. [PMID: 29025787 PMCID: PMC5967425 DOI: 10.2215/cjn.05080517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/06/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Management strategies are unclear for late-onset cytomegalovirus infection occurring beyond 6 months of antiviral prophylaxis in cytomegalovirus high-risk (cytomegalovirus IgG positive to cytomegalovirus IgG negative) kidney transplant recipients. Hybrid strategies (prophylaxis followed by screening) have been investigated but with inconclusive results. There are clinical and potential cost benefits of preventing cytomegalovirus-related hospitalizations and associated increased risks of patient and graft failure. We used decision analysis to evaluate the utility of postprophylaxis screening for late-onset cytomegalovirus infection. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We used the Markov decision analysis model incorporating costs and utilities for various cytomegalovirus clinical states (asymptomatic cytomegalovirus, mild cytomegalovirus infection, and cytomegalovirus infection necessitating hospitalization) to estimate cost-effectiveness of postprophylaxis cytomegalovirus screening strategies. Five strategies were compared: no screening and screening at 1-, 2-, 3-, or 4-week intervals. Progression to severe cytomegalovirus infection was modeled on cytomegalovirus replication kinetics. Incremental cost-effectiveness ratios were calculated as a ratio of cost difference between two strategies to difference in quality-adjusted life-years starting with the low-cost strategy. One-way and probabilistic sensitivity analyses were performed to test model's robustness. RESULTS There was an incremental gain in quality-adjusted life-years with increasing screening frequency. Incremental cost-effectiveness ratios were $783 per quality-adjusted life-year (every 4 weeks over no screening), $1861 per quality-adjusted life-year (every 3 weeks over every 4 weeks), $10,947 per quality-adjusted life-year (every 2 weeks over every 3 weeks), and $197,086 per quality-adjusted life-year (weekly over every 2 weeks). Findings were sensitive to screening cost, cost of hospitalization, postprophylaxis cytomegalovirus incidence, and graft loss after cytomegalovirus infection. No screening was favored when willingness to pay threshold was <$14,000 per quality-adjusted life-year, whereas screening weekly was favored when willingness to pay threshold was >$185,000 per quality-adjusted life-year. Screening every 2 weeks was the dominant strategy between willingness to pay range of $14,000-$185,000 per quality-adjusted life-year. CONCLUSIONS In cytomegalovirus high-risk kidney transplant recipients, compared with no screening, screening for postprophylactic cytomegalovirus viremia is associated with gains in quality-adjusted life-years and seems to be cost effective. A strategy of screening every 2 weeks was the most cost-effective strategy across a wide range of willingness to pay thresholds.
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Affiliation(s)
- Chethan M. Puttarajappa
- Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania; and
- Renal-Electrolyte Division, Department of Medicine and
| | - Sundaram Hariharan
- Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania; and
- Renal-Electrolyte Division, Department of Medicine and
| | - Kenneth J. Smith
- Department of Medicine, Section of Decision Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
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6
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Noble J, Gatault P, Sautenet B, Gaudy-Graffin C, Beby-Defaux A, Thierry A, Essig M, Halimi JM, Munteanu E, Alain S, Buchler M. Predictive factors of spontaneous CMV DNAemia clearance in kidney transplantation. J Clin Virol 2018; 99-100:38-43. [DOI: 10.1016/j.jcv.2017.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/18/2017] [Accepted: 12/20/2017] [Indexed: 12/26/2022]
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7
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Azevedo* LS, Pierrotti LC, Abdala E, Costa SF, Strabelli TMV, Campos SV, Ramos JF, Latif AZA, Litvinov N, Maluf NZ, Filho HHC, Pannuti CS, Lopes MH, dos Santos VA, da Cruz Gouveia Linardi C, Yasuda MAS, de Sousa Marques HH. Cytomegalovirus infection in transplant recipients. Clinics (Sao Paulo) 2015; 70:515-23. [PMID: 26222822 PMCID: PMC4496754 DOI: 10.6061/clinics/2015(07)09] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 03/31/2015] [Accepted: 03/31/2015] [Indexed: 12/12/2022] Open
Abstract
Cytomegalovirus infection is a frequent complication after transplantation. This infection occurs due to transmission from the transplanted organ, due to reactivation of latent infection, or after a primary infection in seronegative patients and can be defined as follows: latent infection, active infection, viral syndrome or invasive disease. This condition occurs mainly between 30 and 90 days after transplantation. In hematopoietic stem cell transplantation in particular, infection usually occurs within the first 30 days after transplantation and in the presence of graft-versus-host disease. The major risk factors are when the recipient is cytomegalovirus seronegative and the donor is seropositive as well as when lymphocyte-depleting antibodies are used. There are two methods for the diagnosis of cytomegalovirus infection: the pp65 antigenemia assay and polymerase chain reaction. Serology has no value for the diagnosis of active disease, whereas histology of the affected tissue and bronchoalveolar lavage analysis are useful in the diagnosis of invasive disease. Cytomegalovirus disease can be prevented by prophylaxis (the administration of antiviral drugs to all or to a subgroup of patients who are at higher risk of viral replication) or by preemptive therapy (the early diagnosis of viral replication before development of the disease and prescription of antiviral treatment to prevent the appearance of clinical disease). The drug used is intravenous or oral ganciclovir; oral valganciclovir; or, less frequently, valacyclovir. Prophylaxis should continue for 90 to 180 days. Treatment is always indicated in cytomegalovirus disease, and the gold-standard drug is intravenous ganciclovir. Treatment should be given for 2 to 3 weeks and should be continued for an additional 7 days after the first negative result for viremia.
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Affiliation(s)
- Luiz Sergio Azevedo*
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Lígia Camera Pierrotti
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Edson Abdala
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Silvia Figueiredo Costa
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Tânia Mara Varejão Strabelli
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Silvia Vidal Campos
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Jéssica Fernandes Ramos
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Acram Zahredine Abdul Latif
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Nadia Litvinov
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Natalya Zaidan Maluf
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Helio Hehl Caiaffa Filho
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Claudio Sergio Pannuti
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Marta Heloisa Lopes
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Vera Aparecida dos Santos
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Camila da Cruz Gouveia Linardi
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Maria Aparecida Shikanai Yasuda
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
| | - Heloisa Helena de Sousa Marques
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Committee for Infection in Immunosuppressed Patients, São Paulo/SP, Brazil
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Valenzuela F, Papp KA, Pariser D, Tyring SK, Wolk R, Buonanno M, Wang J, Tan H, Valdez H. Effects of tofacitinib on lymphocyte sub-populations, CMV and EBV viral load in patients with plaque psoriasis. BMC DERMATOLOGY 2015; 15:8. [PMID: 25951857 PMCID: PMC4436155 DOI: 10.1186/s12895-015-0025-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/20/2015] [Indexed: 12/16/2022]
Abstract
Background Plaque psoriasis is a debilitating skin condition that affects approximately 2% of the adult population and for which there is currently no cure. Tofacitinib is an oral Janus kinase inhibitor that is being investigated for psoriasis. Methods The design of this study has been reported previously (NCT00678210). Patients with moderate to severe chronic plaque psoriasis received tofacitinib (2 mg, 5 mg, or 15 mg) or placebo, twice daily, for 12 weeks. Lymphocyte sub-populations, cytomegalovirus (CMV) and Epstein-Barr virus (EBV) DNA were measured at baseline and up to Week 12. Results Tofacitinib was associated with modest, dose-dependent percentage increases from baseline in median B cell count at Week 4 (24–68%) and Week 12 (18–43%) and percentage reductions from baseline in median natural killer cell count at Week 4 (11–40%). The proportion of patients with detectable CMV and EBV DNA (defined as >0 copies/500 ng total DNA) increased post-baseline in tofacitinib-treated patients. However, multivariate analyses found no relationship between changes in CMV or EBV viral load and changes in lymphocyte sub-populations or tofacitinib treatment. Conclusions Twelve weeks of treatment with tofacitinib had no clinically significant effects on CMV or EBV viral load, suggesting that lymphocyte sub-populations critical to the response to chronic viral infections and viral reactivation were not significantly affected. Replication of these findings during long-term use of tofacitinib will allow confirmation of this observation.
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Affiliation(s)
- Fernando Valenzuela
- Department of Dermatology, Faculty of Medicine, University of Chile and Probity Medical Research, Santiago, Chile.
| | - Kim A Papp
- Clinical Research and Probity Medical Research, Waterloo, ON, Canada.
| | - David Pariser
- Department of Dermatology, Eastern Virginia Medical School and Virginia Clinical Research Inc., Norfolk, VA, USA.
| | - Stephen K Tyring
- Department of Dermatology, University of Texas Medical School, Houston, TX, USA.
| | | | | | - Jeff Wang
- Quintiles, Cambridge, MA, USA. .,Present address: Statistical Consulting & Solutions, LLC, Brookline, MA, USA.
| | | | - Hernan Valdez
- Pfizer Inc, New York, NY, USA. .,Specialty Care Medicines Development Group, Pfizer Inc, 219 E 42nd Street, 7th Floor Room 50, NYO 219/07/01, New York, NY, 10017, USA.
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9
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Martín-Gandul C, Pérez-Romero P, Blanco-Lobo P, Benmarzouk-Hidalgo OJ, Sánchez M, Gentil MA, Bernal C, Sobrino JM, Rodríguez-Hernández MJ, Cordero E. Viral load, CMV-specific T-cell immune response and cytomegalovirus disease in solid organ transplant recipients at higher risk for cytomegalovirus infection during preemptive therapy. Transpl Int 2014; 27:1060-8. [DOI: 10.1111/tri.12378] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/23/2014] [Accepted: 06/17/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Cecilia Martín-Gandul
- Unit of Infectious Disease, Microbiology and Preventive Medicine; Instituto de Biomedicina de Sevilla (IBiS); University Hospital Virgen del Rocío/CSIC/University of Sevilla; Sevilla Spain
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015); Instituto de Salud Carlos III; Madrid Spain
| | - Pilar Pérez-Romero
- Unit of Infectious Disease, Microbiology and Preventive Medicine; Instituto de Biomedicina de Sevilla (IBiS); University Hospital Virgen del Rocío/CSIC/University of Sevilla; Sevilla Spain
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015); Instituto de Salud Carlos III; Madrid Spain
| | - Pilar Blanco-Lobo
- Unit of Infectious Disease, Microbiology and Preventive Medicine; Instituto de Biomedicina de Sevilla (IBiS); University Hospital Virgen del Rocío/CSIC/University of Sevilla; Sevilla Spain
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015); Instituto de Salud Carlos III; Madrid Spain
| | - Omar J. Benmarzouk-Hidalgo
- Unit of Infectious Disease, Microbiology and Preventive Medicine; Instituto de Biomedicina de Sevilla (IBiS); University Hospital Virgen del Rocío/CSIC/University of Sevilla; Sevilla Spain
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015); Instituto de Salud Carlos III; Madrid Spain
| | - Magdalena Sánchez
- Unit of Infectious Disease, Microbiology and Preventive Medicine; Instituto de Biomedicina de Sevilla (IBiS); University Hospital Virgen del Rocío/CSIC/University of Sevilla; Sevilla Spain
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015); Instituto de Salud Carlos III; Madrid Spain
| | - Miguel A. Gentil
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015); Instituto de Salud Carlos III; Madrid Spain
- Service of Nephrology; Hospital Universitario Virgen del Rocío; Sevilla Spain
| | - Carmen Bernal
- Hepatobiliary and Pancreatic Surgery and Hepatic Transplant Unit; Hospital Universitario Virgen del Rocío; Sevilla Spain
| | - José M. Sobrino
- Service of Cardiology; Hospital Universitario Virgen del Rocío; Sevilla Spain
| | - María J. Rodríguez-Hernández
- Unit of Infectious Disease, Microbiology and Preventive Medicine; Instituto de Biomedicina de Sevilla (IBiS); University Hospital Virgen del Rocío/CSIC/University of Sevilla; Sevilla Spain
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015); Instituto de Salud Carlos III; Madrid Spain
| | - Elisa Cordero
- Unit of Infectious Disease, Microbiology and Preventive Medicine; Instituto de Biomedicina de Sevilla (IBiS); University Hospital Virgen del Rocío/CSIC/University of Sevilla; Sevilla Spain
- Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015); Instituto de Salud Carlos III; Madrid Spain
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10
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Cytomegalovirus viral load kinetics in patients with HIV/AIDS admitted to a medical intensive care unit: a case for pre-emptive therapy. PLoS One 2014; 9:e93702. [PMID: 24699683 PMCID: PMC3974798 DOI: 10.1371/journal.pone.0093702] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 03/06/2014] [Indexed: 12/27/2022] Open
Abstract
Background Cytomegalovirus (CMV) infection is associated with severe diseases in immunosuppressed patients; however, there is a lack of data for pre-emptive therapy in patients with HIV/AIDS. Method This was a retrospective study, which enrolled patients diagnosed with HIV/AIDS (CD4<200 cells/μl), who had detectable CMV viral load (VL) during their stay in an adult medical intensive care unit between 2009–2012. Results After screening 82 patients’ records, 41 patients met the enrolment criteria. Their median age was 37 (interquartile range [IQR]: 31–46), and median CD4 count was 29 cells/μl (IQR: 5–55). Sixteen patients (39%) had serial measurements of CMV VL before treatment with ganciclovir. Patients whose baseline CMV VL values were between 1,000–3,000 copies/ml had significantly higher values (median of 14,650 copies/ml) on follow-up testing done 4–12 days later. Those with undetectable VLs at baseline testing had detectable VLs (median of 1,590 copies/ml) mostly within 20 days of follow-up testing. Patients who had VLs >1,000 copies/ml at baseline testing had significantly higher mortality compared to those who had <1,000 copies/ml {hazard ratio of 3.46, p = 0.003 [95% confidence interval (CI): 1.55–7.71]}. Analysis of the highest CMV VL per patient showed that patients who had VLs of >5,100 copies/ml and did not receive ganciclovir had 100% mortality compared to 58% mortality in those who received ganciclovir at VLs of >5,100 copies/ml, 50% mortality in those who were not treated and had low VLs of <5,100 copies/ml, and 44% mortality in those who had ganciclovir treatment at VLs of <5,100 copies/ml (p = 0.084, 0.046, 0.037, respectively). Conclusion This study showed a significantly increased mortality in patients with HIV/AIDS who had high CMV VLs, and suggests that a threshold value of 1,000 copies/ml may be appropriate for pre-emptive treatment in this group.
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Clinical utility of viral load in management of cytomegalovirus infection after solid organ transplantation. Clin Microbiol Rev 2014; 26:703-27. [PMID: 24092851 DOI: 10.1128/cmr.00015-13] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The negative impact of cytomegalovirus (CMV) infection on transplant outcomes warrants efforts toward improving its prevention, diagnosis, and treatment. During the last 2 decades, significant breakthroughs in diagnostic virology have facilitated remarkable improvements in CMV disease management. During this period, CMV nucleic acid amplification testing (NAT) evolved to become one of the most commonly performed tests in clinical virology laboratories. NAT provides a means for rapid and sensitive diagnosis of CMV infection in transplant recipients. Viral quantification also introduced several principles of CMV disease management. Specifically, viral load has been utilized (i) for prognostication of CMV disease, (ii) to guide preemptive therapy, (iii) to assess the efficacy of antiviral treatment, (iv) to guide the duration of treatment, and (v) to indicate the risk of clinical relapse or antiviral drug resistance. However, there remain important limitations that require further optimization, including the interassay variability in viral load reporting, which has limited the generation of standardized viral load thresholds for various clinical indications. The recent introduction of an international reference standard should advance the major goal of uniform viral load reporting and interpretation. However, it has also become apparent that other aspects of NAT should be standardized, including sample selection, nucleic acid extraction, amplification, detection, and calibration, among others. This review article synthesizes the vast amount of information on CMV NAT and provides a timely review of the clinical utility of viral load testing in the management of CMV in solid organ transplant recipients. Current limitations are highlighted, and avenues for further research are suggested to optimize the clinical application of NAT in the management of CMV after transplantation.
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Severe cytomegalovirus infections in immunocompetent patients at admission as dengue mimic: successful treatment with intravenous ganciclovir. ASIAN PAC J TROP MED 2013; 5:920-2. [PMID: 23146811 DOI: 10.1016/s1995-7645(12)60173-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 05/15/2012] [Accepted: 07/15/2012] [Indexed: 11/22/2022] Open
Abstract
Cytomegalovirus (CMV) infection is associated with adverse clinical outcomes in immunosuppressed persons. The incidence and association of CMV reactivation with adverse clinical outcomes in critically ill persons lacking evidence of immunosuppression at ICU admission has received great attention in the practice of critical care medicine. Critically ill patients in ICU who had associated risk factors such as mechanical ventilation, severe sepsis, or blood transfusion are more prone to CMV activation, which in turn led to increased mortality and morbidity in terms of increased ICU stay, longer duration of mechanical ventilation, and higher rates of nosocomial infections. However, severe CMV as initial presentation mimicking dengue infection is rare. We recently came across seven cases with positive CMV serology at ICU admission, which we discuss in the light of current literature.
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Kalil AC, Mindru C, Botha JF, Grant WJ, Mercer DF, Olivera MA, McCartan MA, McCashland TM, Langnas AN, Florescu DF. Risk of cytomegalovirus disease in high-risk liver transplant recipients on valganciclovir prophylaxis: a systematic review and meta-analysis. Liver Transpl 2012; 18:1440-7. [PMID: 22887929 DOI: 10.1002/lt.23530] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 07/24/2012] [Indexed: 02/07/2023]
Abstract
Valganciclovir (VGC) was approved by the Food and Drug Administration in 2004 as cytomegalovirus (CMV) prophylaxis except for liver transplant recipients because of their high incidence of CMV disease with this drug. However, surveys have shown its common off-label use for CMV prophylaxis in liver transplant recipients. We aimed to evaluate the risk of CMV disease with VGC prophylaxis in liver transplant recipients. All studies that evaluated liver transplant recipients and used VGC (900 or 450 mg daily) for the prevention of CMV disease were included. Five controlled studies (n = 483) were pooled with a random effects model; five single-arm studies (n = 380) were pooled for the prevalence rate of CMV disease. The risk of CMV disease with VGC versus ganciclovir was 1.81 [95% confidence interval (CI) = 1.00-3.29, P = 0.05, I(2) = 0%]. For high-risk (donor-positive/recipient-negative) patients, the risk of CMV disease was 1.96 (95% CI = 1.05-3.67, P = 0.035, I(2) = 0%). The risk of CMV disease remained significant with 900 mg of VGC daily (P = 0.04) but not with 450 mg of VGC daily (P = 0.76). The risk of leukopenia with VGC was 1.87 (95% CI = 1.03-3.37, P = 0.04, I(2) = 0%). In single-arm trials, the overall CMV disease rate was 12% (95% CI = 9%-16%, P < 0.001), and the rate for high-risk patients was 20% (95% CI = 10%-38%, P = 0.002). In conclusion, 900 mg of VGC daily may not be safe as CMV prophylaxis in high-risk liver transplant recipients because of the significant 2-fold increase in the risk of CMV disease and the 1.9-fold increase in the risk of leukopenia. Alternative CMV prophylaxis should be used for liver transplant recipients.
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Affiliation(s)
- Andre C Kalil
- Divisions of Infectious Diseases,University of Nebraska Medical Center, Omaha, NE 68198, USA.
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Martín-Gandul C, Pérez-Romero P, Sánchez M, Bernal G, Suárez G, Sobrino M, Merino L, Cisneros JM, Cordero E. Determination, validation and standardization of a CMV DNA cut-off value in plasma for preemptive treatment of CMV infection in solid organ transplant recipients at lower risk for CMV infection. J Clin Virol 2012; 56:13-8. [PMID: 23131346 DOI: 10.1016/j.jcv.2012.09.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 09/04/2012] [Accepted: 09/06/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND Valganciclovir preemptive therapy guided by the viral load is the current strategy recommended for preventing CMV disease in CMV-seropositive Solid Organ Transplant Recipients (SOTR) at lower risk for developing CMV infection. However, universal viral load cut-off has not been established for initiating therapy. OBJECTIVES Our goal was to define and validate a standardized cut-off determined in plasma by real-time PCR assay for initiating preemptive therapy in this population. STUDY DESIGN A prospective cohort study of consecutive cases of CMV-seropositive SOTR was carried out. The cut-off value was determined in a derivation cohort and was validated in the validation cohort. Viral loads were determined using the Quant CMV LightCycler 2.0 real-time PCR System (Roche Applied Science) and results were standardized using the WHO International Standard for human CMV. RESULTS A viral load of 3983 IU/ml (2600 copies/ml) was established as the optimal cut-off for initiating preemptive therapy in a cohort of 141 patients with 982 tests and validated in a cohort of 252 recipients with a total of 2022 test. This cut-off had a 99.6% NPV indicating that the great majority of patients at lower risk will not develop CMV disease without specific antiviral therapy. The high sensitivity and specificity (89.9% and 88.9%, respectively) and the relatively small numbers of patients with CMV disease confirm that real-time PCR was optimal. CONCLUSIONS We have established a cut-off viral load for starting preemptive therapy for CMV-seropositive SOT recipients. Our results emphasized the importance of a mandatory follow-up protocol for CMV-seropositive patients receiving preemptive treatment.
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Affiliation(s)
- C Martín-Gandul
- Unit of Infectious Disease, Microbiology and Preventive Medicine, Instituto de Biomedicina de Sevilla, University Hospital Virgen del Rocío/CSIC/University of Sevilla, Spain.
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Weseslindtner L, Kerschner H, Steinacher D, Nachbagauer R, Kundi M, Jaksch P, Simon B, Hatos-Agyi L, Scheed A, Klepetko W, Puchhammer-Stöckl E. Prospective analysis of human cytomegalovirus DNAemia and specific CD8+ T cell responses in lung transplant recipients. Am J Transplant 2012; 12:2172-80. [PMID: 22548920 DOI: 10.1111/j.1600-6143.2012.04076.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In lung transplant recipients (LuTRs), human cytomegalovirus (HCMV) DNAemia may be associated with HCMV disease and reduced survival of the allograft. Because T cells are essential for controlling HCMV replication, we investigated in this prospective study whether the kinetics of plasma HCMV DNA loads in LuTRs are associated with HCMV-specific CD8+ T cell responses, which were longitudinally assessed using a standardized assay. Sixty-seven LuTRs were monitored during the first year posttransplantation, with a mean of 17 HCMV DNA PCR quantifications and 11.5 CD8+ T cell tests performed per patient. HCMV-specific CD8+ T cell responses displayed variable kinetics in different patients, differed significantly before the onset of HCMV DNAemia in LuTRs who subsequently experienced episodes of DNAemia with high (>1000 copies/mL) and low plasma DNA levels (p = 0.0046, Fisher's exact test), and were absent before HCMV disease. In HCMV-seropositive LuTRs, high-level DNAemia requiring preemptive therapy occurred more frequently when HCMV-specific CD8+ T cell responses fluctuated, were detected only after HCMV DNA detection, or remained undetectable (p = 0.0392, Fisher's exact test). Thus, our data indicate that HCMV-specific CD8+ T cells influence the magnitude of HCMV DNAemia episodes, and we propose that a standardized measurement of CD8+ T cell immunity might contribute to monitoring the immune status of LuTRs posttransplantation.
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Affiliation(s)
- L Weseslindtner
- Department of Virology, Medical University of Vienna, Vienna, Austria
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Florescu DF, Langnas AN, Grant W, Mercer DF, Botha J, Qiu F, Shafer L, Kalil AC. Incidence, risk factors, and outcomes associated with cytomegalovirus disease in small bowel transplant recipients. Pediatr Transplant 2012; 16:294-301. [PMID: 22212495 DOI: 10.1111/j.1399-3046.2011.01628.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite improved prophylaxis, monitoring, and more efficient immunosuppression, CMV infection remains a common opportunistic infection in transplant recipients. We assessed the incidence of CMV disease in pediatric SBT recipients, the timing of CMV disease after transplantation, and its impact on patient outcome. The medical records of 98 SBT recipients were reviewed. We performed descriptive analysis, regression analysis, and Kaplan-Meier curves to determine the time-to-event after transplantation. Fifty-three percent patients were male and 47% female, with a mean age of 38.3 months. Thirty-five percent of patients received prophylactic VGC, 55% GCV, 10% a combination of GCV/VGC, and 99% CMV immunoglobulins. A total of 24.5% recipients were CMV D+/R- (CMV serostatus donor positive/recipient negative). Seven (c. 7%) patients developed CMV disease. CMV disease was associated with 2.5 times (0.52-12.1; p = 0.25) higher rate of CMV mismatch and 11.1 times (1.3-95.9; p = 0.03) higher risk of death. CMV prophylaxis increased time-to-death (p = 0.074). Time-to-CMV disease was shorter in patients with enteritis (p < 0.0001), and CMV disease was associated with shorter time-to-death after transplantation (p = 0.001). CMV disease in SBT recipients was associated with an 11-fold mortality increase and a fourfold faster time-to-death. Time-to-death was significantly shorter with CMV enteritis.
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Affiliation(s)
- D F Florescu
- Infectious Diseases Division, Transplant Infectious Diseases Program, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5400, USA.
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Successful corneal autograft after clearance of anterior chamber cytomegalovirus with oral valganciclovir in a patient with multiple failed corneal allografts. Cornea 2011; 30:1054-7. [PMID: 21673567 DOI: 10.1097/ico.0b013e3182120f73] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report a case of recurrent corneal graft failure because of cytomegalovirus (CMV) infection and to demonstrate successful clearance of the virus with oral valganciclovir, confirmed by polymerase chain reaction (PCR) assay. This allowed for a successful corneal autograft to be performed. METHODS Interventional case report. RESULTS A 90-year-old white man with 4 previous corneal graft failures in his right eye is presented. His visual acuity was no light perception in the left eye subsequent to ocular trauma. His initial penetrating keratoplasty for pseudophakic bullous keratopathy was from a human leukocyte antigen-matched multiorgan donor who was CMV-seropositive. An anterior chamber paracentesis was performed to exclude an infective etiology. CMV was detected on PCR of aqueous humor. After a 12-week course of oral valganciclovir, a repeat aqueous PCR test confirmed the clearance of CMV. A corneal autograft from his left eye was subsequently performed with good outcome. CONCLUSIONS We present a case of successful corneal autograft after clearance of CMV from the anterior chamber (PCR confirmed) in a patient treated with oral valganciclovir.
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Atkinson C, Emery VC. Cytomegalovirus quantification: where to next in optimising patient management? J Clin Virol 2011; 51:223-8. [PMID: 21620764 DOI: 10.1016/j.jcv.2011.04.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 04/11/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Over the years quantification of cytomegalovirus (HCMV) load in blood has become a mainstay of clinical management helping direct deployment of antiviral therapy, assess response to therapy and highlight cases of drug resistance. AIMS The review focuses on a brief historical perspective of HCMV quantification and the ways in which viral load is being used to improve patient management. METHODS A review of the published literature and also personal experience at the Royal Free Hospital. RESULTS Quantification of HCMV is essential for efficient patient management. The ability to use real time quantitative PCR to drive pre-emptive therapy has improved patient management after transplantation although the threshold viral loads for deployment differ between laboratories. The field would benefit from access to a universal standard for quantification. CONCLUSIONS We see that HCMV quantification will continue to be central to delivering individualised patient management and facilitating multicentre trials of new antiviral agents and vaccines in a variety of clinical settings.
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Affiliation(s)
- Claire Atkinson
- Centre for Virology, Department of Infection, UCL London, United Kingdom
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Shanahan A, Malani P, Kaul D. Relapsing cytomegalovirus infection in solid organ transplant recipients. Transpl Infect Dis 2009; 11:513-8. [DOI: 10.1111/j.1399-3062.2009.00443.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Prevalence and mortality associated with cytomegalovirus infection in nonimmunosuppressed patients in the intensive care unit. Crit Care Med 2009; 37:2350-8. [PMID: 19531944 DOI: 10.1097/ccm.0b013e3181a3aa43] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Cytomegalovirus is the most common viral opportunistic infection in immunocompromised patients. However, recent studies have demonstrated active cytomegalovirus infection in nonimmunosuppressed intensive care unit patients. OBJECTIVE To define the frequency and mortality rate associated with cytomegalovirus infection in nonimmunosuppressed patients in the intensive care unit. METHODS A systematic review up to October 2008 was performed. Pooled results were analyzed by fixed- and random-effects models. Cochran Q and I2 were performed for heterogeneity. RESULTS Thirteen studies (n = 1258) were selected. The overall rate of active cytomegalovirus infection was 17% (95% confidence interval [CI], 11% to 24%; p < .0001; I2 = 86%). When the patients were screened for > or =5 intensive care unit days, the overall rate of infection increased to 21% (95% CI, 15% to 29%; p < .001). The infection rate for studies that used cytomegalovirus DNA/antigen for diagnosis was 20% (95% CI, 13% to 31%; p < .0001) and for studies that used culture was 12% (95% CI, 6% to 22%; p < .0001). The cytomegalovirus rate for patients with unknown serology was 7% (95% CI, 3% to 14%; p < .0001), whereas the rate for patients with positive serology was 31% (95% CI, 22% to 42%; p < .0001). The rate of infection was higher in patients with severe sepsis: 32% (95% CI, 22% to 45%; p < .0001). And in patients with high disease severity: 32% (95% CI, 23% to 42%; p < .0001). The overall mortality rate associated with active cytomegalovirus infection was 1.93 times (95% CI, 1.29 to 2.88; p = .001) as high as that without cytomegalovirus infection. CONCLUSIONS Active cytomegalovirus infection occurs frequently in nonimmunosuppressed patients in intensive care, especially in those with positive cytomegalovirus serology, intensive care unit stay > or =5 days, severe sepsis, and high disease severity, in whom the rate of cytomegalovirus infection is up to 36%. Mortality rate is significantly doubled with cytomegalovirus, but a cause-effect relationship cannot be established yet. A large prospective cohort study on the patient population identified by our findings is needed to define who is at the highest risk for developing active cytomegalovirus infection and to determine its effects on mortality.
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Cytomegalovirus DNA Load Patterns Developing After Lung Transplantation Are Significantly Correlated With Long-Term Patient Survival. Transplantation 2009; 87:1720-6. [DOI: 10.1097/tp.0b013e3181a60b4e] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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