title: Cytomegalovirus load in whole blood is more reliable for predicting and assessing CMV disease than pp65 antigenaemia.
abstract: CMV is a common cause of disease in immunocompromised patients. Because sampling of the diseased organ can be invasive, markers of systemic CMV reactivation such as pp65 and CMV viral load are commonly used to monitor patients at risk of CMV disease. In this retrospective analysis, the performance of these markers was compared in solid organ transplant recipients, patients with haematological malignancies and HIV infection. Both assays were sensitive markers of reactivation, however, the predictive value for disease of a positive result for both was low. Compared to viral load, the pp65 assay was a less sensitive marker of CMV reactivation. It was only positive when the viral load was greater than 3 log (10) copies/ml whole blood and was negative in 10 instances when the viral load was between 3 and 5 logs. In concordantly positive samples, the number of pp65 positive cells varied widely relative to the viral load and the number of positive cells counted could not be used to predict disease likelihood with any certainty. To conclude, CMV viral load provides a more consistent guide to determine likelihood of disease than pp65 count and is a more sensitive marker of CMV reactivation.
authors.affiliation: National Health Laboratory Service and Division of Virology, Faculty of Health Sciences, University of Cape Town, Anzio Rd, Observatory, 7925 Cape Town, South Africa. Diana.Hardie@uct.ac.za
authors.forename: Diana R
authors.initials: DR
authors.lastname: Hardie
authors.forename: Stephen N J
authors.initials: SN
authors.lastname: Korsman
authors.forename: Nei-yuan
authors.initials: NY
authors.lastname: Hsiao
mesh_terms: D019411:Clinical Laboratory Techniques / Q000379:methods*; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000821:virology; D015658:HIV Infections / Q000150:complications; D019337:Hematologic Neoplasms / Q000150:complications; D006801:Humans; D016377:Organ Transplantation / Q000009:adverse effects; D010750:Phosphoproteins / Q000097:blood*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014180:Transplantation; D019562:Viral Load; D014763:Viral Matrix Proteins / Q000097:blood*; D014775:Virus Activation
chemical_list: D010750:Phosphoproteins; D014763:Viral Matrix Proteins; C065418:cytomegalovirus matrix protein 65kDa
keywords: CMV viral load; Human cytomegalovirus; pp65 antigenaemia