title: Parvovirus B19 (B19) and cytomegalovirus (CMV) infections and  anti-erythropoietin (anti-EPO) antibodies in patients on dialysis  hyporesponsive to erythropoietin therapy.
abstract: BACKGROUND
  Approximately 10% of patients receiving recombinant human erythropoietin (rHuEPO) do not respond to the treatment. We evaluated parvovirus B19 (B19) and cytomegalovirus (CMV) infections and antierythropoietin (anti-EPO) antibodies as potential causes of anemia in dialyzed patients, hyporesponsive to rHuEPO.
  
  
  METHODS
  Data from 120 dialyzed patients, receiving rHuEPO alfa, were collected: demographic characteristics, rHuEPO dose, duration of rHuEPO treatment and time on dialysis, etiology of chronic kidney disease and transfusion history. Serology and PCR were performed to address B19 and CMV infection status. An ELISA was developed to detect anti-EPO antibodies.
  
  
  RESULTS
  rHuEPO resistance correlated with high ferritin levels (p = 0.001) and short time on dialysis (p = 0.012). B19 DNA was found in 10 (8.3%) dialyzed patients and CMV DNA was detected in 33 (27.5%). There was no significant correlation between B19 infection and anemia,while a tendency of correlation between active CMV infection and hemoglobin levels or hematocrit value (p= 0.069 and p= 0.070, respectively) has been observed. Anti-EPO antibodies were not detected in any patient.
  
  
  CONCLUSIONS
  B19 infection is a rare complication in dialyzed patients and should be investigated after exclusion of other common causes, while CMV infection is rather common. The role of CMV infection in the hyporesponsiveness in dialyzed patients should be further evaluated in other studies. Our data suggest that anti-EPO antibodies are not involved in rHuEPO resistance in this population.
authors: Michelle Teodoro
authors: MT
authors: Alves
authors: Sandra Simone
authors: SS
authors: Vilaça
authors: Lara Carvalho
authors: LC
authors: Godoi
authors: Leonides
authors: L
authors: Rezende Júnior
authors: Maria das Graças
authors: Md
authors: Carvalho
authors: Franciele de Souza
authors: Fde S
authors: Silva
authors: Flávia Loli
authors: FL
authors: Guimarães
authors: Ana Paula
authors: AP
authors: Fernandes
authors: Luci Maria SantAna
authors: LM
authors: Dusse
authors: Karina Braga
authors: KB
authors: Gomes
mesh_terms: D000328:Adult; D000368:Aged; D057134:Antibodies, Neutralizing / Q000032:analysis*; D000998:Antiviral Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000276:immunology*; D024882:Drug Resistance, Viral; D000068817:Epoetin Alfa; D016731:Erythema Infectiosum / Q000150:complications* / Q000276:immunology*; D004921:Erythropoietin / Q000276:immunology* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016732:Parvovirus B19, Human; D011994:Recombinant Proteins / Q000627:therapeutic use; D012010:Red-Cell Aplasia, Pure / Q000150:complications / Q000276:immunology; D006435:Renal Dialysis
chemical_list: D057134:Antibodies, Neutralizing; D000998:Antiviral Agents; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa