title: Cytomegalovirus and ulcerative colitis: Place of antiviral therapy.
abstract: The link between cytomegalovirus (CMV) infection and inflammatory bowel diseases remains an important subject of debate. CMV infection is frequent in ulcerative colitis (UC) and has been shown to be potentially harmful. CMV reactivation needs to be diagnosed using methods that include in situ detection of viral markers by immunohistochemistry or by nucleic acid amplification techniques. Determination of the density of infection using quantitative tools (numbers of infected cells or copies of the genome) is particularly important. Although CMV reactivation can be considered as an innocent bystander in active flare-ups of refractory UC, an increasing number of studies suggest a deleterious role of CMV in this situation. The presence of colonic CMV infection is possibly linked to a decreased response to steroids and other immunosuppressive agents. Some treatments, notably steroids and cyclosporine A, have been shown to favor CMV reactivation, which seems not to be the case for therapies using anti-tumor necrosis factor drugs. According to these findings, in flare-ups of refractory UC, it is now recommended to look for the presence of CMV reactivation by using quantitative tools in colonic biopsies and to treat them with ganciclovir in cases of high viral load or severe disease.
authors.affiliation: Sylvie Pillet, Bruno Pozzetto, Xavier Roblin, Groupe Immunité des Muqueuses et Agents Pathogènes (GIMAP)-EA3064, Faculty of Medicine of Saint-Etienne, University of Lyon, 69365 Lyon Cedex 7, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Pillet
authors.affiliation: Sylvie Pillet, Bruno Pozzetto, Xavier Roblin, Groupe Immunité des Muqueuses et Agents Pathogènes (GIMAP)-EA3064, Faculty of Medicine of Saint-Etienne, University of Lyon, 69365 Lyon Cedex 7, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pozzetto
authors.affiliation: Sylvie Pillet, Bruno Pozzetto, Xavier Roblin, Groupe Immunité des Muqueuses et Agents Pathogènes (GIMAP)-EA3064, Faculty of Medicine of Saint-Etienne, University of Lyon, 69365 Lyon Cedex 7, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Roblin
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D003106:Colon / Q000187:drug effects / Q000276:immunology / Q000821:virology; D003587:Cytomegalovirus / Q000187:drug effects* / Q000276:immunology / Q000472:pathogenicity; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D015774:Ganciclovir / Q000627:therapeutic use*; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D019562:Viral Load; D014775:Virus Activation / Q000187:drug effects
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D015774:Ganciclovir
keywords: Flare-up; Ganciclovir; Human cytomegalovirus; Inflammation; Inflammatory bowel disease; Intestinal mucosa; Quantitative polymerase chain reaction; Ulcerative colitis; Viral load