Human cytomegalovirus (HCMV) leukoDNAemia correlates more closely with clinical symptoms than antigenemia and viremia in heart and heart-lung transplant recipients with primary HCMV infection

Giuseppe Gerna, Maurizio Zavattoni, Fausto Baldanti, Antonella Sarasini, Lucia Chezzi, Paolo Grossi, M. Grazia Revello

Research output: Contribution to journalArticlepeer-review

Abstract

Background: In the last few years, human cytomegalovirus (HCMV) viremia, pp65 antigenemia, and leuko- and plasma-DNAemia have been developed to quantitate virus in blood of immunocompromised patients with HCMV infection. However, thus far, no conclusive studies have been performed to define the correlation of each of the different assays with clinical symptoms in primary HCMV infections. Methods. This correlation was investigated in a population of 20 heart and heart-lung transplant recipients with primary HCMV infection using standardized virological methods. Results. Median peak HCMV viremia, antigenemia, and leukoDNAemia levels were 110 (0-2,000) p72-positive fibroblasts, 450 (27-2,000) pp65-positive fibroblasts, 450 (27-2,000) pp65- positive leukocytes, and > 10,000 (1,358-10,000) genome equivalents (GE) in the 14 symptomatic patients and 18 (1-130) p72-positive fibroblasts, 86.5 (5- 350) pp65-positive leukocytes, and 248 (10-863) GE in the six asymptomatic patients, respectively. The difference was statistically significant for antigenemia (P=0.009) and leukoDNAemia (P1,000 GE). Follow-up confirmed these results, showing that 1,000-2,000 GE was the threshold zone for emergence of clinical symptoms. Symptoms were never observed in patients with secondary DNA peaks, except for one patient suffering from an HCMV organ localization (HCMV gastritis). Conclusions. LeukoDNAemia is the viral parameter of choice for monitoring of primary HCMV infections and antiviral treatment in heart and heart-lung transplant recipients. In this patient population, antigenemia- guided preemptive therapy could be replaced by leukoDNAemia-based antiviral therapy.

Original languageEnglish
Pages (from-to)1378-1385
Number of pages8
JournalTransplantation
Volume65
Issue number10
DOIs
Publication statusPublished - May 27 1998

ASJC Scopus subject areas

  • Transplantation
  • Immunology

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