Risk Factors for Cytomegalovirus Retinitis in Patients with Cytomegalovirus Viremia after Hematopoietic Stem Cell Transplantation

Jeon, Sohee; Lee, Won Ki; Lee, Yong Eun; Lee, Dong Gun; Lee, Jong Wook

doi:10.1016/j.ophtha.2012.03.032

Cited by 63 publications

(46 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We found that the initiation of preemptive therapy at lower CMV viral loads was associated with shorter episodes of viremia and decreased risk for prolonged viremia lasting >30 days. Prolonged viremia and high peak viral loads are associated with the development of antiviral resistance and CMV disease; thus, efforts towards minimizing duration of viremia may provide substantial clinical benefit(18-21). Additionally, preemptive therapy started at lower viral loads was associated with shorter treatment duration.…”

Section: Discussionmentioning

confidence: 99%

Cytomegalovirus load at treatment initiation is predictive of time to resolution of viremia and duration of therapy in hematopoietic cell transplant recipients

Waggoner

Pinsky

2015

Journal of Clinical Virology

View full text Add to dashboard Cite

Background Preemptive antiviral therapy relies on viral load measurements and is the mainstay of cytomegalovirus (CMV) prevention in hematopoietic cell transplant (HCT) recipients. However, optimal CMV levels for the initiation of preemptive therapy have not been defined. Objectives To evaluate the relationship between plasma CMV DNA levels at initiation of preemptive therapy with time to resolution of viremia and duration of treatment. Study Design Retrospective analysis of HCT recipients undergoing serial CMV PCR testing between June 2011 and June 2014 was performed. Results 221 HCT recipients underwent preemptive therapy for 305 episodes of CMV viremia. Median time to resolution was shorter when treatment was initiated at lower CMV levels (15 days at 135-440 international units (IU)/mL, 18 days at 441-1000 IU/mL, and 21 days at >1000 IU/mL, P <.001). Prolonged viremia lasting >30 days occurred less frequently when treatment was initiated at 135-440 IU/mL compared to 441-1000 IU/mL and >1000 IU/mL (1%, 15%, 24%, P<.001). Median treatment duration was also shorter in the lower viral load groups (28, 34, 37 days, P <.001). Conclusion Initiation of preemptive therapy at low CMV levels was associated with shorter episodes of viremia and courses of antiviral therapy. These data support the utility of initiating preemptive CMV therapy at viral loads as low as 135 IU/mL in HCT recipients.

show abstract

Section: Discussionmentioning

confidence: 99%

Cytomegalovirus load at treatment initiation is predictive of time to resolution of viremia and duration of therapy in hematopoietic cell transplant recipients

Waggoner

Pinsky

2015

Journal of Clinical Virology

View full text Add to dashboard Cite

show abstract

“…Furthermore, systemic testing methods for CMV are routinely used to monitor patients for reactivation and response to treatment in the haematological settings. There are other centres reporting confirmation of CMVR based on systemic testing (Mota et al 2011;Jeon et al 2012;Kobayashi et al 2012;Davis et al 2013;Samia et al 2014;Iu et al 2016). There are other centres reporting confirmation of CMVR based on systemic testing (Mota et al 2011;Jeon et al 2012;Kobayashi et al 2012;Davis et al 2013;Samia et al 2014;Iu et al 2016).…”

Section: Diagnosis Of Cmvrmentioning

confidence: 99%

“…Classically CMVR has been associated with AIDS, and before the advent of highly active retroviral therapy up to 40% of these patients were affected (Palestine et al 1984). Nevertheless, modern immunosuppressive therapies as well as improved survival rates have in recent years increased the incidence of opportunistic infections in other patient populations, and reports of CMVR in HIV-negative patients have been accumulating (Derzko-Dzulynsky et al 1998;Bertelmann et al 2005;Chawla et al 2005;Delyfer et al 2007;Sloan et al 2008;Jeon et al 2012;Bae et al 2013;Davis et al 2013;Gupta et al 2013;Radwan et al 2013;Samia et al 2014;Jeon & Lee 2015;Vishnevskia-Dai et al 2015;Downes et al 2016;Iu et al 2016;Karkhaneh et al 2016).…”

Section: Introductionmentioning

confidence: 99%

Cytomegalovirus retinitis in HIV‐negative patients – associated conditions, clinical presentation, diagnostic methods and treatment strategy

Shapira

Vishnevskia‐Dai

2017

Acta Ophthalmologica

View full text Add to dashboard Cite

In recent years, numerous reports have tied cytomegalovirus retinitis (CMVR) with multiple systemic conditions in the absence of human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). These range from reports in apparently healthy individuals, through conditions rendering limited immune dysfunction such as advanced age and diabetes mellitus, and finally severe immune dysfunction such as in haematological and rheumatological conditions. Reports are also emerging, suggesting that induced local ocular immunosuppression is a risk factor for CMVR. We herein present a comprehensive collection of the accumulated findings regarding CMVR in non-HIV patients. We summarize the spectrum of underlying morbidity that has been associated with CMVR, its clinical presentation, diagnostic methods and treatment choice in the attempt to suggest the optimal treatment strategy in this complicated and diverse patient population which is still currently lacking a consensus.

show abstract

“…CMV disease, particularly CMV retinitis and CMV colitis, is often associated with absent or low level CMV viremia/antigenemia. However, other studies reported a poor positive and negative predictive value of CMV viremia in regard of CMV disease [52,53,54]. In this study, we focused on ''CMV disease'' as a clinical important outcome.…”

Section: Discussionmentioning

confidence: 98%

Low Levels of Mannan-Binding Lectin or Ficolins Are Not Associated with an Increased Risk of Cytomegalovirus Disease in HIV-Infected Patients

et al. 2013

View full text Add to dashboard Cite

BackgroundIn HIV-infected patients, prediction of Cytomegalovirus (CMV) disease remains difficult. A protective role of mannan-binding lectin (MBL) and ficolins against CMV disease has been reported after transplantation, but the impact in HIV-infected patients is unclear.MethodsIn a case-control study nested within the Swiss HIV Cohort Study, we investigated associations between plasma levels of MBL/ficolins and CMV disease. We compared HIV-infected patients with CMV disease (cases) to CMV-seropositive patients without CMV disease (controls) matched for CD4 T-cells, sampling time, and use of combination antiretroviral therapy. MBL and M-ficolin, L-ficolin, and H-ficolin were quantified using ELISA.ResultsWe analysed 105 cases and 105 matched controls. CMV disease was neither associated with MBL (odds ratio [OR] 1.03 per log10 ng/mL increase (95% CI 0.73–1.45)) nor with ficolins (OR per log10 ng/mL increase 0.66 (95% CI 0.28–1.52), 2.34 (95% CI 0.44–12.36), and 0.89 (95% CI 0.26–3.03) for M-ficolin, L-ficolin, and H-ficolin, respectively). We found no evidence of a greater association between MBL and CMV disease in patients with low CD4 counts; however in the multivariable analysis, CMV disease was more likely in patients with an increased HIV RNA (OR 1.53 per log10 copies/mL; 95% CI 1.08–2.16), or a shorter duration of HIV-infection (OR 0.91 per year; 95% CI 0.84–0.98).ConclusionsCMV disease is not associated with low levels of MBL/ficolins, suggesting a lack of a protective role in HIV-infected patients.

show abstract

Risk Factors for Cytomegalovirus Retinitis in Patients with Cytomegalovirus Viremia after Hematopoietic Stem Cell Transplantation

Cited by 63 publications

References 34 publications

Cytomegalovirus load at treatment initiation is predictive of time to resolution of viremia and duration of therapy in hematopoietic cell transplant recipients

Cytomegalovirus load at treatment initiation is predictive of time to resolution of viremia and duration of therapy in hematopoietic cell transplant recipients

Cytomegalovirus retinitis in HIV‐negative patients – associated conditions, clinical presentation, diagnostic methods and treatment strategy

Low Levels of Mannan-Binding Lectin or Ficolins Are Not Associated with an Increased Risk of Cytomegalovirus Disease in HIV-Infected Patients

Contact Info

Product

Resources

About