title: Viral escape and T-cell immunity during ganciclovir treatment of cytomegalovirus infection: case report of a pancreatico-renal transplant recipient.
abstract: BACKGROUND
  Pancreas-kidney transplant recipients are at high risk for cytomegalovirus (CMV) disease despite prophylactic ganciclovir therapy. Because the impact of antiviral therapy on anti-CMV immune reactions is unknown, CMV-specific T-cell subsets in primary and recurrent CMV infection were analyzed in a pancreas-kidney transplant case study.
  
  
  METHODS
  Major histocompatibility complex class I tetramers were used to detect peripheral CMV pp65-specific CD8 T cells. Intracellular cytokine staining was used to determine the frequency of CMV-specific CD4 T cells. Conventional virologic parameters and routine laboratory parameters were monitored. For ganciclovir resistance testing, CMV-UL97 genotyping was performed.
  
  
  RESULTS
  Despite prophylactic ganciclovir therapy, primary CMV infection induced in vivo expansion of activated CMV-specific CD8 T cells. Interestingly, viral dissemination during recurrent CMV disease was a result of partially ganciclovir-resistant CMV. Recovery after discontinued ganciclovir treatment was associated with the expansion of CMV-specific CD4 T cells.
  
  
  CONCLUSIONS
  Immunologic monitoring may contribute to clinical management of recurrent CMV disease.
authors.affiliation: Department of Gastroenterology, University of Cologne, Cologne, Germany. Christine. Benz@medizin.uni-koeln.de.
authors.forename: Christine
authors.initials: C
authors.lastname: Benz
authors.forename: Gisela
authors.initials: G
authors.lastname: Holz
authors.forename: Detlef
authors.initials: D
authors.lastname: Michel
authors.forename: Sabine
authors.initials: S
authors.lastname: Awerkiew
authors.forename: Volker
authors.initials: V
authors.lastname: Dries
authors.forename: Dirk
authors.initials: D
authors.lastname: Stippel
authors.forename: Tobias
authors.initials: T
authors.lastname: Goeser
authors.forename: Dirk H
authors.initials: DH
authors.lastname: Busch
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology; D003092:Colitis / Q000473:pathology / Q000821:virology; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000209:etiology* / Q000276:immunology; D015774:Ganciclovir / Q000627:therapeutic use*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects*; D012008:Recurrence; D016176:T-Lymphocyte Subsets / Q000187:drug effects / Q000276:immunology*
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir