Comparison of cytomegalovirus antigenemia and culture assays in patients on and off antiviral therapy

Abstract

We examined 1,869 consecutive blood specimens from 529 patients (>80% organ transplant recipients) for detection of CMV by antigenemia and culture assays, and compared results between patients on and off antiviral therapy. All 1,869 specimens were tested by the shell vial assay and antigenemia, and 503 were also tested by standard tube culture. The overall positivity rate for each test was 17.0% for antigenemia, 1.8% for shell vial culture assay, and 0.7% by tube culture. No specimens were positive by either shell vial or tube culture, while negative by antigenemia. These findings were consistent across all organ transplant and other patient types. Shell vial positivity was associated with higher antigenemia levels in patients either on or off anti-CMV drug therapy. Among the shell vial positive specimens, the antigenemia counts were higher in patients on antiviral drug therapy as compared to those not on therapy. We conclude that the pp65 antigenemia assay is superior to culture methods for detection of CMV in blood, particularly for patients on anti-CMV drug treatment. Additionally, its quantitative nature renders the antigenemia assay an excellent tracking tool for both resolution of asymptomatic, low level CMV reactivations and response of CMV infection to antiviral treatment.

Relevance of cytomegalovirus infection and coronary-artery remodeling in the first year after heart transplantation: a prospective three-dimensional intravascular ultrasound study

“…However, the association of CMV with TxCAD requires confirmation: although initial studies suggested the involvement of CMV in the pathogenesis of Tx-CAD (23,24), further investigations were unable to corroborate this association (19 -21). These discrepancies can probably be explained by the retrospective study design (23), the inadequacy of coronary angiography for TxCAD diagnosis (18), and by the insufficiently sensitive techniques used for CMV infection detection (25). Our prospective IVUS-based analysis focused on the occurrence of CMV infection as assessed by the pp65 antigenemia test (14).…”

“…Our prospective IVUS-based analysis focused on the occurrence of CMV infection as assessed by the pp65 antigenemia test (14). This assay expresses an accurate index of viral load in the blood and thus provides a highly sensitive tool to drive preemptive treatment (25,26). Furthermore, although previous IVUS-based studies examined TxCAD risk factors focusing only on intimal thickness (20,21), we analyzed coronary lumen behavior as the result of the interplay between both intimal hyperplasia and the vessel wall.…”

Lymphocyte subpopulations during cytomegalovirus disease in renal transplant recipients

“…Cytomegalovirus is one of the most im- * portant infectious agents that attack transplant patients and is responsible for the significant morbidity and mortality presented by organ recipients (2,16). Since antigenemia started to be used as a quantitative marker of viral load, more extensive studies on the interaction between CMV and host immune response have become possible.…”

“…Cytomegalovirus (CMV) is one of the most important causes of infectious complications in organ transplant recipients (1,2). It occurs in 43-92% of kidney transplant recipients during the first months after transplantation and is associated with a greater net state of immunosuppression (3).…”