title: Preemptive treatment for the prevention of cytomegalovirus disease: in lung and heart transplant recipients.
abstract: BACKGROUND
  Rapid quantifiable diagnostic techniques for the diagnosis of cytomegalovirus (CMV) infection may predict patients at risk of CMV pneumonitis and allow preemptive antiviral treatment.
  
  
  METHODS
  Using CMV antigenemia as a prospective surveillance technique for CMV infection, we compared the outcome of preemptive treatment (PT) with ganciclovir, 10 mg/kg/day for 21 days directed by "high levels" of CMV antigenemia (PT group, n= 19), with the outcome in a group of historical controls (n=18) treated with ganciclovir when CMV illness occurred. Greater than 50 antigen-positive cells per 2 x 10(5) polymorphonuclear leukocytes was considered to be high-level antigenemia.
  
  
  RESULTS
  Nine of the 18 controls developed high-level CMV antigenemia at a median of 33 days (range: 13-65 days) and 5 of the 9 developed CMV disease. Ten of the 19 PT group had high levels of CMV antigenemia detected at a median of 47 days (range: 20-63 days) and were given ganciclovir; none developed CMV disease. There was a significantly lower incidence of CMV disease in the PT group in comparison to controls (0 of 19 vs. 5 of 18: P=0.019).
  
  
  CONCLUSIONS
  We have reduced the incidence of CMV disease using preemptive treatment, and because of a 100% negative predictive value, we omitted unnecessary antiviral prophylaxis for many at-risk patients.
authors.affiliation: North West Lung Centre, Wythenshawe Hospital, Manchester, England. JJGEgan@aol.com
authors.forename: J J
authors.initials: JJ
authors.lastname: Egan
authors.forename: J
authors.initials: J
authors.lastname: Lomax
authors.forename: L
authors.initials: L
authors.lastname: Barber
authors.forename: S S
authors.initials: SS
authors.lastname: Lok
authors.forename: R
authors.initials: R
authors.lastname: Martyszczuk
authors.forename: N
authors.initials: N
authors.lastname: Yonan
authors.forename: A
authors.initials: A
authors.lastname: Fox
authors.forename: A K
authors.initials: AK
authors.lastname: Deiraniya
authors.forename: A J
authors.initials: AJ
authors.lastname: Turner
authors.forename: A A
authors.initials: AA
authors.lastname: Woodcock
mesh_terms: D000914:Antibodies, Viral / Q000627:therapeutic use; D000956:Antigens, Viral / Q000032:analysis; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D007116:Immunization, Passive; D007165:Immunosuppression Therapy / Q000379:methods; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged
chemical_list: D000914:Antibodies, Viral; D000956:Antigens, Viral; D015774:Ganciclovir