Quantitative Polymerase Chain Reaction to Predict Occurrence of Symptomatic Cytomegalovirus Infection and Assess Response to Ganciclovir Therapy in Renal Transplant Recipients

• Published in: The Journal of infectious diseases 1998-09, Vol.178 (3), p.626-635
• Main Authors: Roberts, Thomas C., Brennan, Daniel C., Buller, Richard S., Gaudreault-Keener, Monique, Schnitzler, Mark A., Sternhell, Kara E., Garlock, Kathryn A., Singer, Gary G., Storch, Gregory A.
• Format: Article
• Language: English
• Subjects: Adult; Antiviral Agents - therapeutic use; Biological and medical sciences; Blood; Blood plasma; Cytomegalovirus; Cytomegalovirus - genetics; Cytomegalovirus - isolation & purification; Cytomegalovirus infections; Cytomegalovirus Infections - blood; Cytomegalovirus Infections - drug therapy; Cytomegalovirus Infections - physiopathology; Cytomegalovirus Infections - virology; DNA, Viral; Female; Fundamental and applied biological sciences. Psychology; Ganciclovir - therapeutic use; Human cytomegalovirus; Human viral diseases; Humans; Infections; Infectious diseases; Kidney Transplantation; Leukocytes; Leukocytes, Mononuclear - virology; Major Articles; Male; Medical sciences; Microbiology; Middle Aged; Multivariate Analysis; Polymerase chain reaction; Polymerase Chain Reaction - methods; Postoperative Complications - virology; Predictive Value of Tests; Specimens; Techniques used in virology; Transplantation; Treatment Outcome; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Virology
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1086/515383

Cytomegalovirus (CMV) DNA levels were measured by quantitative-competitive polymerase chain reaction (PCR) in weekly leukocyte samples from 50 renal transplant recipients, including 23 with symptomatic and 27 with asymptomatic CMV infection. Peak and week 4 CMV DNA levels were higher in symptomatic subjects (P = .07 and .02, respectively). In a logistic regression model, the logarithm of the week 4 level independently predicted symptomatic infection (odds ratio, 1.78 for a 1 log10 increase; 95% confidence interval, 1.14–2.78; P = .01). All subjects whose week 4 level exceeded 1000 copies/100,000 leukocytes developed symptoms. In subjects with adequate samples for analysis, CMV levels declined exponentially with ganciclovir treatment, with an average half-life of 3.3 days. Levels exceeding 10,000 copies were associated with prolonged time to clearing of CMV DNA. Potential clinical applications of quantitative CMV PCR include predicting occurrence of symptomatic first episodes after transplantation and individualizing duration of antiviral therapy.