Association of quantitative cytomegalovirus antigenemia with symptomatic infection in solid organ transplant patients

Niubó, Jordi; Pérez, J L; Martinez‐Lacasa, Javier; García, Alberto Urbaneja; Roca, Josep; Fabregat, Joan; Gil-Vernet, S.; Martin, R. Russell

doi:10.1016/0732-8893(95)00248-0

Cited by 46 publications

(28 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The result of the test is reported as the number of positive cells per total number of cells counted (2,3). Because pp65 is secreted during viral replication, its detection in peripheral blood leukocytes (PBL) generally signifies active CMV infection (83,84).…”

Section: Antigen Testingmentioning

confidence: 99%

Clinical Utility of Viral Load in Management of Cytomegalovirus Infection after Solid Organ Transplantation

2013

View full text Add to dashboard Cite

SUMMARY The negative impact of cytomegalovirus (CMV) infection on transplant outcomes warrants efforts toward improving its prevention, diagnosis, and treatment. During the last 2 decades, significant breakthroughs in diagnostic virology have facilitated remarkable improvements in CMV disease management. During this period, CMV nucleic acid amplification testing (NAT) evolved to become one of the most commonly performed tests in clinical virology laboratories. NAT provides a means for rapid and sensitive diagnosis of CMV infection in transplant recipients. Viral quantification also introduced several principles of CMV disease management. Specifically, viral load has been utilized (i) for prognostication of CMV disease, (ii) to guide preemptive therapy, (iii) to assess the efficacy of antiviral treatment, (iv) to guide the duration of treatment, and (v) to indicate the risk of clinical relapse or antiviral drug resistance. However, there remain important limitations that require further optimization, including the interassay variability in viral load reporting, which has limited the generation of standardized viral load thresholds for various clinical indications. The recent introduction of an international reference standard should advance the major goal of uniform viral load reporting and interpretation. However, it has also become apparent that other aspects of NAT should be standardized, including sample selection, nucleic acid extraction, amplification, detection, and calibration, among others. This review article synthesizes the vast amount of information on CMV NAT and provides a timely review of the clinical utility of viral load testing in the management of CMV in solid organ transplant recipients. Current limitations are highlighted, and avenues for further research are suggested to optimize the clinical application of NAT in the management of CMV after transplantation.

show abstract

Section: Antigen Testingmentioning

confidence: 99%

Clinical Utility of Viral Load in Management of Cytomegalovirus Infection after Solid Organ Transplantation

2013

View full text Add to dashboard Cite

show abstract

“…It gives both a qualitative and a quantitative result, which closely correlates with viremia and clinical disease severity. 43,44 Although the test is highly sensitive and specific for the diagnosis of CMV infection, it is less specific for CMV disease. In addition, reproducibility between different laboratories is inconsistent and requires immediate processing of the sample.…”

Section: Viral Cultures and Antigenemia Assaysmentioning

confidence: 99%

Management of cytomegalovirus infection after liver transplantation

Sampathkumar

Payá

2000

Liver Transpl

View full text Add to dashboard Cite

“…Available methods for the detection and monitoring of the CMV load include the quantification of the pp65 antigen in blood leukocytes and CMV DNA amplification. The pp65 antigen assay remains a reference method and has been validated in several clinical trials (7,9,11,15). The assay has several drawbacks, including its limited sensitivity for leukopenic hematopoeitic stem cell recipients and the labor-intensive procedures.…”

mentioning

confidence: 99%

Improved Monitoring of Cytomegalovirus Infection after Allogeneic Hematopoietic Stem Cell Transplantation by an Ultrasensitive Plasma DNA PCR Assay

Kaiser

Perrin

Chapuis³

et al. 2002

J Clin Microbiol

View full text Add to dashboard Cite

Cytomegalovirus (CMV) DNA amplification assays in plasma have shown limited sensitivity compared to the detection of pp65 antigen in leukocytes. Our goal was to increase the sensitivity of a commercial CMV DNA PCR quantitative assay. After modification, the new assay was able to reproducibly detect 20 CMV DNA copies/ml of plasma. We compared this new ultrasensitive PCR assay with the standard PCR and the pp65 test for CMV detection and quantification in 22 consecutive allogeneic hematopoietic stem cell recipients. CMV infection or reactivation was detected in 84 of 319 (26%) samples by the ultrasensitive PCR assay compared to 38 of 319 (12%) samples by the pp65 assay (P < 0.01). All samples positive by the pp65 assay were positive by the ultrasensitive PCR, and CMV episodes were detected on average 4 days earlier and 7 days later than the first and the last pp65-positive test, respectively. In addition, during CMV episodes, the ultrasensitive assay identified positive samples that were inconsistently detected by the pp65 assay. The ultrasensitive assay was also much more sensitive than the standard PCR, with 26 versus 12% of CMV DNA-positive samples (P < 0.01). This assay improved the monitoring of CMV infection or reactivation in hematopoietic allogeneic stem cell recipients.Cytomegalovirus (CMV) is a leading cause of infection in allogeneic hematopoietic stem cell transplant patients. Preemptive therapy with ganciclovir or foscarnet is the most commonly used strategy to prevent CMV disease or complications, but it requires close quantification of the CMV load. Available methods for the detection and monitoring of the CMV load include the quantification of the pp65 antigen in blood leukocytes and CMV DNA amplification. The pp65 antigen assay remains a reference method and has been validated in several clinical trials (7,9,11,15). The assay has several drawbacks, including its limited sensitivity for leukopenic hematopoeitic stem cell recipients and the labor-intensive procedures. CMV DNA amplification assays in the format of a quantitative plasma-based PCR have the potential for higher sensitivity, and they are not dependent on the leukocyte count. Another potential advantage is that plasma can easily be stored before being processed. However, in previous reports, plasma-based PCR assays were either not standardized or displayed limited sensitivity compared to whole-blood PCR or the pp65 assay (1, 13).Our goal was to increase the sensitivity of a standardized plasma-based PCR assay, the Cobas Amplicor CMV Monitor test (Roche Diagnostic Systems, Inc., Branchburg, N.J.). The new ultrasensitive format showed ϳ20-fold-increased sensitivity. After validation, we assessed whether this ultrasensitive PCR could improve the monitoring of the CMV load in allogeneic hematopoietic stem cell transplant patients. We compared the performance of the ultrasensitive PCR to that of the routinely used pp65 antigen assay and to that of the standard Amplicor CMV Monitor test. MATERIALS AND METHODSConsecutive and unselected allogenei...

show abstract

Association of quantitative cytomegalovirus antigenemia with symptomatic infection in solid organ transplant patients

Cited by 46 publications

References 20 publications

Clinical Utility of Viral Load in Management of Cytomegalovirus Infection after Solid Organ Transplantation

Clinical Utility of Viral Load in Management of Cytomegalovirus Infection after Solid Organ Transplantation

Management of cytomegalovirus infection after liver transplantation

Improved Monitoring of Cytomegalovirus Infection after Allogeneic Hematopoietic Stem Cell Transplantation by an Ultrasensitive Plasma DNA PCR Assay

Contact Info

Product

Resources

About