USE OF THE HUMAN CYTOMEGALOVIRUS (HCMV) ANTIGENEMIA ASSAY FOR DIAGNOSIS AND MONITORING OF HCMV INFECTIONS AND DETECTION OF ANTIVIRAL DRUG-RESISTANCE IN THE IMMUNOCOMPROMISED

Background: Quantification of viral load in blood has proven to be hel pful in the follow-up of disseminated HCMV infections in immunocomprom ised patients. Objectives: (i) To describe the antigenemia assay and i ts optimization and (ii) to analyze the use of the antigenemia assay f or the diagnosis and monitoring of HCMV infections and for the detecti on of treatment failures. Study design: This article is intended to gi ve an overview of our experience in the use of the antigenemia assay. Results and conclusions: In solid organ transplant recipients and pati ents with AIDS, HCMV symptomatic infections mostly appear when antigen emia values are > 300 pp65-positive PBL/2 x 10(5) examined. To avoid t he appearance of overt HCMV disease antiviral treatment could be admin istered when antigenemia levels are > 100 pp65-positive PBL/2 x 105 ex amined. Bone marrow transplant recipients show symptomatic HCMV infect ions when antigenemia values are > 100 pp65-positive PBL/2 x 105 exami ned. This group of patients should be treated when antigenemia levels are < 10 pp65-positive PBL/2 x 105 examined due to the higher mortalit y rate associated with HCMV complications. A decrease in antigenemia l evels during therapy indicates a good response to antiviral drug, whil e stable or increasing values document a treatment failure and the eme rgence of drug-resistant HCMV strains. (C) 1998 Elsevier Science B.V. All rights reserved.