Evaluation of cytomegalovirus DNAaemia versus pp65-antigenaemia cutoff for guiding preemptive therapy in transplant recipients: a randomized study.
METHODS
A bicentre, randomized, prospective open-label study aimed at defining a DNAaemia versus antigenaemia cutoff for guiding preemptive therapy of human cytomegalovirus (HCMV) infections in solid organ transplant recipients (SOTR) was completed. Overall, 99 patients were enrolled in the DNAaemia arm and 101 patients in the antigenaemia arm. Patients were randomized to be monitored for HCMV infection in the blood by either assay. Antiviral treatment was started in both seropositive and seronegative patients when levels greater than 300,000 DNA copies/ml blood or 100 pp65-positive leukocytes in the relevant arm were reached.


RESULTS
HCMV infection was detected in 81/99 (81.8%) patients in the DNAaemia arm and in 87/101 (86.1%) patients in the antigenaemia arm (P=ns). Antiviral treatment was given to 23/99 (23.0%) patients in the DNAaemia arm and 42/101 (41.0%) patients in the antigenaemia arm (P = 0.01). In the DNAaemia arm, antiviral therapy was significantly delayed and duration of the first course of treatment was significantly greater than in the antigenaemia arm. However, total duration of treatment was comparable in the two arms. No case of HCMV disease occurred in patients treated after reaching the relevant cutoff. However, four patients (three in the antigenaemia arm, and one in the DNAaemia arm) suffered from HCMV disease prior to reaching the relevant cutoff.


CONCLUSIONS
Compared with antigenaemia, a single DNAaemia cutoff: (i) significantly reduces the number of patients requiring treatment; (ii) may be safely adopted to guide preemptive therapy of both primary and reactivated HCMV infections in SOTR; and (iii) does not significantly modify the overall duration of treatment.
Gerna
Giuseppe
G
Servizio di Virologia, Fondazione, IRCCS Policlinico San Matteo, Pavia, Italy. g.gerna@smatteo.pv.it
Baldanti
Fausto
F
Torsellini
Maria
M
Minoli
Lorenzo
L
Viganò
Mario
M
Oggionnis
Tiberio
T
Rampino
Teresa
T
Castiglioni
Barbara
B
Goglio
Antonio
A
Colledan
Michele
M
Mammana
Carmelo
C
Nozza
Francesca
F
Daniele
Lilleri
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000235:genetics / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000235:genetics / Q000276:immunology / Q000517:prevention & control*; D004279:DNA, Viral / Q000097:blood*; D004334:Drug Administration Schedule; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D016030:Kidney Transplantation; D016031:Liver Transplantation; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D010750:Phosphoproteins / Q000097:blood*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D019562:Viral Load; D014763:Viral Matrix Proteins / Q000097:blood*; D014779:Virus Replication / Q000187:drug effects
D000998:Antiviral Agents; D004279:DNA, Viral; D010750:Phosphoproteins; D014763:Viral Matrix Proteins; C065418:cytomegalovirus matrix protein 65kDa