title: Long-term outcome of inflammatory bowel diseases with cytomegalovirus colitis: effect of antiviral treatment.
abstract: OBJECTIVE
  The role of cytomegalovirus (CMV) reactivation in the outcome of inflammatory bowel diseases (IBDs) is unclear. Uncertainties remain on the treatment of CMV infection, especially in patients with a viral load just above the normal value in the blood or with very few positive cells in colonic biopsies. This retrospective cohort study reports the long-term outcome of 38 active IBD patients with CMV infection, 13 of whom received an antiviral treatment.
  
  
  METHODS
  Thirty patients with ulcerative colitis (UC) and eight patients with Crohn's colitis with active colitis and CMV infection, diagnosed by detection of at least one CMV inclusion by histology and immunohistochemistry and/or with the CMV antigen test or the CMV DNA test, were studied. Their clinical history at 6 months and up to 1 year following hospital discharge was reviewed. Clinical remission at hospital discharge and recurrences requiring new treatments or colectomy were considered major outcomes of the study. The features of treated and untreated patients were compared using the Fisher exact test and the Student t-test.
  
  
  RESULTS
  All patients showed rare CMV inclusions, and only three had positive blood CMV PCR. Thirteen patients received antiviral treatment, whereas 25 patients did not. No patient underwent colectomy during the hospitalization. The 12-month cumulative rate of clinical relapse requiring new treatment or colectomy was 23% in patients treated with antivirals and 50% in untreated patients (P=0.165). However, in patients with UC and in those with steroid-dependent/refractory disease, antiviral treatment was associated with a significantly higher clinical remission rate at 12 months (77.8 vs. 45%, P=0.049, and 77.8 vs. 19.4%, P=0.038, respectively).
  
  
  CONCLUSIONS
  In IBD patients with active CMV colitis, antiviral treatment seems to have a marginal impact in the short term, during the treatment of the acute phase, but it may have some beneficial effect in maintaining remission up to 1 year of follow-up in patients with UC and steroid-dependent/refractory disease.
authors.affiliation: aGastroenterology Unit bPathology Unit, Department of Biomedical and Clinical Sciences, 'L. Sacco' University Hospital, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Maconi
authors.forename: Marta
authors.initials: M
authors.lastname: Lombardini
authors.forename: Federica
authors.initials: F
authors.lastname: Furfaro
authors.forename: Cristina
authors.initials: C
authors.lastname: Bezzio
authors.forename: Pietro
authors.initials: P
authors.lastname: Zerbi
authors.forename: Sandro
authors.initials: S
authors.lastname: Ardizzone
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000628:therapy*; D003424:Crohn Disease / Q000175:diagnosis / Q000628:therapy*; D003587:Cytomegalovirus / Q000187:drug effects* / Q000472:pathogenicity; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D014775:Virus Activation / Q000187:drug effects
chemical_list: D000998:Antiviral Agents