Follow-up of 28 HCMV seropositive renal-transplant recipients: comparison of clinical, biological and virological parameters in the groups of treated versus untreated infected patients.
BACKGROUND
A pre-emptive strategy for prevention of Human Cytomegalovirus (HCMV) disease depends on accurate detection of HCMV infection and clinical and/or biological abnormalities.


OBJECTIVE
The aim of our study was to evaluate a therapeutic strategy based on the presence of either minimal clinical and/or biological symptoms or high HCMV viral load assessed by quantitative real-time PCR from whole blood as previously described.


METHODS
Between June 2002 and July 2003, 70 HCMV seropositive patients underwent a renal transplantation. Virological monitoring was performed every 2 weeks until day 90 then every 3-4 weeks until day 180. Biochemical and haematological parameters were also prospectively monitored.


RESULTS
Twenty-eight patients (40%) showed at least one positive HCMV DNA in whole blood. Based on the following criteria: HCMV viral load greater than 4log(10)/ml, or the persistence of a HCMV DNAemia in two consecutive blood samples, or fever, or leucopenia or neutropenia, or increase in alanine aminotransferase level, 14 of the 28 patients received IV ganciclovir as a pre-emptive treatment. Immunosuppressive therapy and demographical data were comparable in both groups. As far as virological, haematological and biochemical parameters are concerned, no statistical significant difference was observed between treated and untreated patients. Moreover no adverse outcome was observed among untreated patients always having a HCMV viral load below 4log(10)/ml.


CONCLUSIONS
This study reinforces the need of monitoring of HCMV seropositive renal-transplant recipients based on HCMV diagnosis and quantification by real-time PCR. The results showed that HCMV viraemic patients may benefit of absence of antiviral treatment when they have a low viral load (below 4log(10)/ml) and absence of clinical and/or biological abnormalities. Further studies are required now to validate the threshold value at which we should begin pre-emptive therapy.
Kamar
Nassim
N
Unité de Transplantation d'Organes, Hôpital Rangueil, CHU Toulouse, Toulouse, France.
Mengelle
Catherine
C
Yahyaoui
Salah
S
Sandres-Sauné
Karine
K
Durand
Dominique
D
Izopet
Jacques
J
Rostaing
Lionel
L
D000914:Antibodies, Viral / Q000097:blood*; D000998:Antiviral Agents / Q000627:therapeutic use*; D018890:Chemoprevention; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000821:virology; D004279:DNA, Viral / Q000097:blood*; D015774:Ganciclovir / Q000627:therapeutic use*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D016030:Kidney Transplantation / Q000009:adverse effects*; D016133:Polymerase Chain Reaction / Q000379:methods; D016896:Treatment Outcome; D019562:Viral Load
D000914:Antibodies, Viral; D000998:Antiviral Agents; D004279:DNA, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D015774:Ganciclovir