Comparison of Quantitative Cytomegalovirus (CMV) PCR in Plasma and CMV Antigenemia Assay: Clinical Utility of the Prototype AMPLICOR CMV MONITOR Test in Transplant Recipients

Abstract

The correlation between the prototype AMPLICOR CMV MONITOR test (Roche Molecular Systems), a quantitative PCR assay, and the cytomegalovirus (CMV) pp65 antigenemia assay was evaluated in transplant recipients. Sequential blood specimens were collected on 29 patients (491 specimens), the leukocyte fraction was tested by CMV antigenemia, and quantitative PCR was performed on plasma specimens. None of the 15 patients (242 specimens) who were antigenemia negative were positive for CMV DNA by PCR, and none of these patients developed active CMV disease. There were 14 antigenemia-positive patients, 8 of whom developed active CMV disease. In all patients, there was a good association between the antigenemia and PCR assays. Ganciclovir-resistant virus was isolated from three patients with active CMV disease. These three patients had persistently elevated levels of antigenemia and CMV DNA by PCR when resistance to ganciclovir developed. This standardized, quantitative CMV PCR assay on plasma has clinical utility for the diagnosis of active disease and in monitoring the response to antiviral therapy in transplant recipients.

Infection in Renal Transplant Recipients

“…Intercurrent infections (flu-like illness, headache, confusion, myalgias, cough) might be the harbinger of important infection (West Nile virus, severe acute respiratory syndrome [SARS], T. cruzi). Live donors undergo a battery of serological tests (Table 29- 7), purified protein derivative (PPD) skin test, and, if indicated, chest radiograph. The testing must be individualized based on unique risk factors (e.g., travel).…”

“…Quantitation of the intensity of CMV infection has been linked to the risk for infection in transplant recipients. 7,33,42,50,65 Two types of quantitative assays have been developed-molecular and antigen detection assays. The antigenemia assay is a semiquantitative fluorescent assay in which circulating neutrophils are stained for CMV early antigen (pp65) that is taken up nonspecifically as a measure of the total viral burden in the body.…”

Molecular Microbiology

“…Viral load values decrease rapidly after appropriate antiviral therapy is begun, and CMV DNA is cleared from the plasma within several weeks of initiation of therapy. [92][93][94] Failure of viral loads to decrease promptly should raise concerns of possible treatment failure because persistently elevated concentrations of CMV DNA during therapy indicates therapeutic resistance. Molecular assays can also identify patients at risk for relapsing CMV infection.…”

Quantifizierung von CMV-DNA als diagnostisches Werkzeug zur verbesserten Behandlung und berwachung von Risikopatienten/CMV Genome Quantification as a Diagnostic Tool for Improving Treatment and Monitoring of Risk Patients

“…Dieser Ansatz basiert auf der regelma Èûigen U È berwachung der Patienten mit Hilfe geeigneter Nachweisme- [9,14]. Die am besten geeigneten quantitativen Testmethoden vereinen dabei ein notwendiges Maximum an Sensitivita Èt mit einem mo Èglichst guten Vorhersagewert bezu Èglich der Krankheitsentwicklung [30,31].…”