title: Cytomegalovirus, inflammatory bowel disease, and anti-TNFα.
abstract: OBJECTIVE
  Anti-TNFα agents emerged in inflammatory bowel disease (IBD) as an effective option in situations that, otherwise, would be refractory to medical therapy. Cytomegalovirus infection may present with a high spectrum of manifestations and lead to high morbidity and mortality. However, its clinical significance in IBD course remains unknown and data on its association with anti-TNFα are limited.
  
  
  OBJECTIVE
  This study aims to evaluate cytomegalovirus (CMV) infection/disease in patients with IBD treated with anti-TNFα; if possible, possible risk factors associated with CMV infection/disease in IBD patients under anti-TNFα as well as the influence of CMV infection/disease in IBD course would be determined.
  
  
  METHODS
  During three consecutive years, all IBD patients starting infliximab in our department were included. Cytomegalovirus status before anti-TNFα was evaluated. Data regarding IBD, therapeutic and IBD course after infliximab, were recorded. CMV analysis was performed with polymerase chain reaction (PCR)-cytomegalovirus in peripheral blood and colonoscopy with biopsies (histopathology/immunohistochemistry).
  
  
  RESULTS
  We included 29 patients: female-83%; Crohn's disease-51.8%, ulcerative colitis-44.8%, non-classified colitis-3.4%; 23 cytomegalovirus seropositive. Median follow-up: 19 months (3-36). During follow-up, 14 patients were under combination therapy with azathioprine and 5 did at least 1 cycle of corticosteroids. Twenty-one patients responded to infliximab. We registered 8 exacerbations of IBD. Four patients discontinued infliximab: none had CMV infection. We documented 1 case of intestinal cytomegalovirus infection-detected in biopsies performed per protocol in an asymptomatic UC patient, who responded to valganciclovir without infliximab discontinuation.
  
  
  CONCLUSIONS
  Infliximab, with/without immunosuppression, does not confer an increased risk of (re)activation of cytomegalovirus. Cytomegalovirus was not responsible neither for significant morbidity nor mortality in IBD.
authors.affiliation: Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Praçeta Prof. Mota Pinto, 3000-075, Coimbra, Portugal. saratcampos@gmail.com.
authors.forename: Sara T
authors.initials: ST
authors.lastname: Campos
authors.affiliation: Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Praçeta Prof. Mota Pinto, 3000-075, Coimbra, Portugal.
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Portela
authors.affiliation: Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Praçeta Prof. Mota Pinto, 3000-075, Coimbra, Portugal.
authors.forename: Luís
authors.initials: L
authors.lastname: Tomé
mesh_terms: D003093:Colitis, Ulcerative / Q000150:complications / Q000188:drug therapy / Q000821:virology; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy / Q000821:virology; D003587:Cytomegalovirus / Q000502:physiology*; D003586:Cytomegalovirus Infections / Q000150:complications / Q000188:drug therapy / Q000821:virology; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy / Q000378:metabolism* / Q000821:virology*; D000069285:Infliximab / Q000627:therapeutic use; D008297:Male; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology*; D028761:Withholding Treatment
chemical_list: D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab
keywords: Anti-TNFα agents; Cytomegalovirus infection; Immunomodulators; Inflammatory bowel disease