HUMAN CYTOMEGALOVIRUS (HCMV) LEUKODNAEMIA CORRELATES MORE CLOSELY WITH CLINICAL SYMPTOMS THAN ANTIGENEMIA AND VIREMIA IN HEART AND HEART-LUNG TRANSPLANT RECIPIENTS WITH PRIMARY HCMV INFECTION
G. Gerna et al., HUMAN CYTOMEGALOVIRUS (HCMV) LEUKODNAEMIA CORRELATES MORE CLOSELY WITH CLINICAL SYMPTOMS THAN ANTIGENEMIA AND VIREMIA IN HEART AND HEART-LUNG TRANSPLANT RECIPIENTS WITH PRIMARY HCMV INFECTION, Transplantation, 65(10), 1998, pp. 1378-1385
Background, In the last few years, human cytomegalovirus (HCMV) viremi
a, pp65 antigenemia, and leuko- and plasma-DNAemia have been developed
to quantitate virus in blood of immunocompromised patients with HCMV
infection. However thus far, no conclusive studies have been performed
to define the correlation of each of the different assays With clinic
al symptoms in primary HCMV infections. Methods. This correlation was
investigated in a population of 20 heart and heart-lung transplant rec
ipients with primary HCMV infection using standardized virological met
hods. Results. Median peak HCMV viremia, antigenemia, and leukoDNAemia
levels were 110 (0-2,000) p72-positive fibroblasts, 450 (27-2,000) pp
65-positive leukocytes, and >10,000 (1,358-10,000) genome equivalents
(GE) in the 14 symptomatic patients and 18 (1-130) p72-positive fibrob
lasts, 86.5 (5-350) pp65-positive leukocytes, and 248 (10-863) GE in t
he six asymptomatic patients, respectively. The difference was statist
ically significant for antigenemia (P=0.009) and leukoDNAemia (P<0.000
1). However, on an individual basis, unlike viremia and antigenemia, a
ll DNA peaks of the 6 asymptomatic patients were below the DNA range o
f the 14 symptomatic patients (<1,000 GE), while all the 14 symptomati
c patients had DNA peaks higher than those of asymptomatic patients (>
1,000 GE). Follow-up confirmed these results, showing that 1,000-2,000
GE was the threshold zone for emergence of clinical symptoms. Symptom
s were never observed in patients with secondary DNA peaks, except for
one patient suffering from an HCMV organ localization (HCMV gastritis
), Conclusions. LeukoDNAemia is the viral parameter of choice for moni
toring of primary HCMV infections and antiviral treatment in heart and
heart-lung transplant recipients. In this patient population, antigen
-emia-guided preemptive therapy could be replaced by leukoDNAemia-base
d antiviral therapy.