Clinical applications of interferon-γ releasing assays for cytomegalovirus to differentiate cytomegalovirus disease from bystander activation: a pilot proof-of-concept study

• Published in: The Korean journal of internal medicine 2017, 32(5), , pp.900-909
• Main Authors: Kim, Sung-Han, Lee, Ho-Su, Lee, Hyun-Jung, Kim, Sun-Mi, Shin, Sung, Park, Sang-Hyoung, Kim, Kyung-Jo, Kim, Young-Hoon, Sung, Heungsup, Lee, Sang-Oh, Choi, Sang-Ho, Yang, Suk-Kyun, Kim, Yang Soo, Woo, Jun Hee, Han, Duck-Jong
• Format: Article
• Language: English
• Subjects: Adult; Biomarkers - metabolism; Bystander Effect; Coinfection; Cytomegalovirus - immunology; Cytomegalovirus Infections - diagnosis; Cytomegalovirus Infections - immunology; Cytomegalovirus Infections - metabolism; Cytomegalovirus Infections - virology; Enzyme-Linked Immunospot Assay; Female; Host-Pathogen Interactions; Humans; Immunocompromised Host; Interferon-gamma - immunology; Interferon-gamma - metabolism; Interferon-gamma Release Tests; Male; Middle Aged; Original; Pilot Projects; Pneumocystis carinii - immunology; Pneumonia, Pneumocystis - diagnosis; Pneumonia, Pneumocystis - immunology; Pneumonia, Pneumocystis - microbiology; Pneumonia, Viral - diagnosis; Pneumonia, Viral - immunology; Pneumonia, Viral - virology; Predictive Value of Tests; Proof of Concept Study; Prospective Studies; Viral Load; Virus Activation; 내과학
• ISSN: 1226-3303; 2005-6648
• DOI: 10.3904/kjim.2015.354

We evaluated the proposed clinical application of the combined interpretation of host factors and viral factors in two different cytomegalovirus (CMV) co-infection models. We prospectively enrolled all human immunodeficiency virus non-infected patients with confirmed pneumonia (PCP) and those with suspected gastrointestinal CMV disease in a tertiary hospital. All patients underwent CMV interferon-γ releasing assay (IGRA) for CMV (T-track CMV, Lophius Biosciences). We created the 2-axis model with the CMV IGRA results as the x-axis and the results for CMV virus replication as the y-axis, and hypothesized that cases falling in the left upper quadrant (high viral load and low CMV-specific immunity) of the model would be true CMV infections. The CMV IGRA results were concealed from the attending physicians. Of 39 patients with PCP, four (10%) were classified as combined CMV pneumonia, 13 (33%) as bystander activation, and the remaining 22 (56%) as no CMV infection. The data for all four patients with PCP and CMV pneumonia fell in the left upper quadrant of the 2-axis model. Of 24 patients with suspected gastrointestinal CMV disease, 12 (50%) were classified as gastrointestinal CMV disease and the remaining 12 (50%) as bystander activation with no gastrointestinal CMV disease. The data for 11 of the 12 patients (92%) with gastrointestinal CMV disease were located in the left upper quadrant of the 2-axis model. Cases yielding low CMV IGRA results and high CMV viral replication appear to be true CMV infections. Further studies with large number of cases in different types of CMV disease should be proposed.