title: Cytomegalovirus is frequently reactivated and disappears without antiviral agents in ulcerative colitis patients.
abstract: OBJECTIVE
  The clinical significance of cytomegalovirus (CMV) reactivation complicating ulcerative colitis (UC) patients has been uncertain. It has therefore remained undetermined whether or not CMV reactivation should be treated in UC patients under immunosuppression. The aim of the study was to clarify the natural history of CMV reactivation in UC patients.
  
  
  METHODS
  Sixty-nine UC patients with moderate to severe activity were enrolled in the study. All of the patients were treated with prednisolone, and/or immunosuppressants such as cyclosporine A. We sequentially monitored CMV reactivation every 2 wk up until 8 wk using the CMV antigenemia (Ag) assay and plasma quantitative real-time polymerase chain reaction (PCR) assay for CMV.
  
  
  RESULTS
  Immunoglobulin (Ig) G for CMV was positive in 48 patients (69.6%) and negative in 21 patients (30.4%). CMV was reactivated in 25 patients out of the 48 seropositive patients (52.1%) during the study period. The CMV Ag and PCR values were low and none of the patients showed any evidence of CMV infection on biopsy specimens by hematoxylin and eosin staining. While gancylovir (GCV) was not used except in two patients, clinical outcomes including rates of remission and colectomy were not significantly different among the CMV reactivation-positive, -negative, and CMV IgG negative groups. Furthermore, CMV disappeared without GCV in most of the CMV reactivation-positive patients.
  
  
  CONCLUSIONS
  CMV is frequently reactivated in active UC patients; however, it disappears without antiviral agents. Therefore, antiviral therapies should not be necessary for most UC patients with only CMV reactivation as long as CMV Ag values are low.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Matsuoka
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Iwao
authors.forename: Takeshi
authors.initials: T
authors.lastname: Mori
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sakuraba
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yajima
authors.forename: Tadakazu
authors.initials: T
authors.lastname: Hisamatsu
authors.forename: Susumu
authors.initials: S
authors.lastname: Okamoto
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Morohoshi
authors.forename: Motoko
authors.initials: M
authors.lastname: Izumiya
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ichikawa
authors.forename: Toshiro
authors.initials: T
authors.lastname: Sato
authors.forename: Nagamu
authors.initials: N
authors.lastname: Inoue
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Ogata
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Hibi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000888:Antibodies, Anti-Idiotypic / Q000032:analysis; D000956:Antigens, Viral / Q000032:analysis; D001706:Biopsy; D003093:Colitis, Ulcerative / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D003106:Colon / Q000473:pathology / Q000821:virology; D016572:Cyclosporine / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000302:isolation & purification / Q000502:physiology*; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000473:pathology / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D020133:Reverse Transcriptase Polymerase Chain Reaction; D016896:Treatment Outcome; D014775:Virus Activation
chemical_list: D000888:Antibodies, Anti-Idiotypic; D000956:Antigens, Viral; D004279:DNA, Viral; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D016572:Cyclosporine