Background. Viral loads (VLs) frequently are followed during treatment of symptomatic congenital cytomegalovirus disease, but their predictive value is unclear. Methods.Post hoc analysis of 2 antiviral studies was performed. Seventy-three subjects were treated for 6 weeks and 47 subjects were treated for 6 months. Whole blood VL was determined by real-time polymerase chain reaction before and during therapy.Results.Higher baseline VL was associated with central nervous system involvement (3.82 log, range 1–5.65 vs 3.32 log, range 1–5.36; P = .001), thrombocytopenia (3.68 log, range 1–5.65 vs 3.43 log, range 1–5.36; P = .03), and transaminitis at presentation (3.73 log, range 1–5.60 vs 3.39 log, range 1–5.65; P = .009), but with overlap in the amount of virus detected between groups. In subjects treated for 6 months, lower VL at presentation correlated with better hearing outcomes at 12 months, but VL breakpoints predictive of hearing loss were not identified. Sustained viral suppression during 6 months of therapy correlated with better hearing outcomes at 6, 12, and 24 months (P = .01, P = .0007, P = .04), but a majority without viral suppression still had improved hearing.Conclusions.In infants with symptomatic congenital cytomegalovirus disease, higher whole blood VL before initiation of anti-viral therapy has no clinically meaningful predictive value for long-term outcomes.Keywords. antiviral therapy; congenital CMV infection; hearing loss; viral load
Blood Viral Load in Symptomatic Congenital Cytomegalovirus Infection / Marsico, Concetta; Aban, Immaculada; Kuo, Huichien; James, Scott H; Sanchez, Pablo J; Ahmed, Amina; Arav-Boger, Ravit; Michaels, Marian G; Ashouri, Negar; Englund, Janet A; Estrada, Benjamin; Jacobs, Richard F; Romero, Jose R; Sood, Sunil K; Whitworth, Suzanne; Jester, Penelope M; Whitley, Richard J; Kimberlin, David W. - In: THE JOURNAL OF INFECTIOUS DISEASES. - ISSN 0022-1899. - ELETTRONICO. - 219:(2019), pp. 1398-1406. [10.1093/infdis/jiy695]
Blood Viral Load in Symptomatic Congenital Cytomegalovirus Infection
Marsico, Concetta
;
2019
Abstract
Background. Viral loads (VLs) frequently are followed during treatment of symptomatic congenital cytomegalovirus disease, but their predictive value is unclear. Methods.Post hoc analysis of 2 antiviral studies was performed. Seventy-three subjects were treated for 6 weeks and 47 subjects were treated for 6 months. Whole blood VL was determined by real-time polymerase chain reaction before and during therapy.Results.Higher baseline VL was associated with central nervous system involvement (3.82 log, range 1–5.65 vs 3.32 log, range 1–5.36; P = .001), thrombocytopenia (3.68 log, range 1–5.65 vs 3.43 log, range 1–5.36; P = .03), and transaminitis at presentation (3.73 log, range 1–5.60 vs 3.39 log, range 1–5.65; P = .009), but with overlap in the amount of virus detected between groups. In subjects treated for 6 months, lower VL at presentation correlated with better hearing outcomes at 12 months, but VL breakpoints predictive of hearing loss were not identified. Sustained viral suppression during 6 months of therapy correlated with better hearing outcomes at 6, 12, and 24 months (P = .01, P = .0007, P = .04), but a majority without viral suppression still had improved hearing.Conclusions.In infants with symptomatic congenital cytomegalovirus disease, higher whole blood VL before initiation of anti-viral therapy has no clinically meaningful predictive value for long-term outcomes.Keywords. antiviral therapy; congenital CMV infection; hearing loss; viral loadI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
