A Prospective Study of Cytomegalovirus-Specific Cell-Mediated Immune Monitoring and Cytomegalovirus Infection in Patients With Active Systemic Lupus Erythematosus Receiving Immunosuppressants

Abstract

Introduction The effects of cytomegalovirus (CMV)-specific cell-mediated immunity (CMI) on CMV infection in patients with autoimmune diseases receiving immunosuppressants have not been explored. Methods Patients with active systemic lupus erythematosus (SLE) were preemptively monitored for clinically significant CMV infection (CsCMVI, defined as plasma CMV DNA loads > 3 log10 IU/mL). CMV-specific CMI was assessed using an enzyme-linked immunosorbent assay (QuantiFERON-CMV®, QF) before as well as 1 and 3 months after intense immunosuppressive therapy. Results The study included 55 patients with active SLE; patients had a mean age of 34 years (standard deviation [SD] 13 years), a median SLEDAI-2K score of 14 (SD 8), and 93% were female. Most patients had renal involvement (67%), received methylprednisolone (93%), and were CMV seropositive (95%). Thirteen (23.6%) patients developed CsCMVI. Among patients with active SLE who were QF-negative (QF–) and QF-positive (QF+) before receiving immunosuppressive therapy, 28.6% and 25% developed CsCMVI, respectively (p=0.69). However, 1 month post-immunosuppression, more QF– than QF+ patients developed CsCMVI (44.4% vs. 11.8%, p=0.03; adjusted hazard ratio 4.97 [95% confidence interval 1.07–23.10], p=0.04). Conclusions Patients with active SLE and low CMV-specific T cell responses could develop CMV infection after receiving immunosuppressants. Further studies should focus on CMV-specific CMI among patients with autoimmune diseases.

Cytomegalovirus infection and disease in systemic lupus erythematosus patients at a high-complexity hospital in southwestern Colombia

“…Its findings show that the risk of CMV reactivation was correlated with QuantiFERON-CMV levels after 1 month of intense immunosuppression. 27 To our knowledge, this is the first publication evaluating SLE patients with CMV infection/disease in a Colombian population. Nevertheless, it has some important limitations to consider.…”

A Framework to Overcome Challenges in the Management of Infections in Patients with Systemic Lupus Erythematosus

“…CMV infection in SLE may present as gastrointestinal bleed, colitis, hepatitis, retinitis, or encephalitis, with a high incidence of pneumonitis. 32 High dose of glucocorticoids, cyclophosphamide, plasma exchange, pancytopenia and concurrent infections have been associated with serious CMV clinical syndrome. High CMV viral loads are associated with the development of CMV infection in patients with SLE.…”

Cytomegalovirus infection in liver-transplanted children

“…The manifestations of primary CMV infection are more severe than CMV reinfection or reactivation from latent endogenous virus[ 49 ]. Current guidelines consider D + /R − children to be the most prone to developing severe CMV disease from primary infection[ 50 ].…”

“…The assay reflects cell-mediated immunity by measuring IFN-γ levels following in vitro stimulation of CD8+ T cells by CMV peptides. The subsequent incidence of CMV disease in immunocompromised patients is significantly lower among those with a positive result than those with a negative result[ 21 , 50 , 63 ]. A multicentre cohort study showed that the positive and negative predictive values of the assay were 0.90 and 0.27, respectively[ 50 ].…”

“…The subsequent incidence of CMV disease in immunocompromised patients is significantly lower among those with a positive result than those with a negative result[ 21 , 50 , 63 ]. A multicentre cohort study showed that the positive and negative predictive values of the assay were 0.90 and 0.27, respectively[ 50 ]. Many assays are in use in some centres for monitoring during prophylaxis or pre-emptive therapy[ 55 ] (Tables 2 and 3 ).…”