Blood Viral Load in Symptomatic Congenital Cytomegalovirus Infection.
Administration, Intravenous
Administration, Oral
Antiviral Agents
/ administration & dosage
Central Nervous System Diseases
/ virology
Child Development
Cytomegalovirus
/ genetics
Cytomegalovirus Infections
/ blood
DNA, Viral
/ blood
Female
Ganciclovir
/ therapeutic use
Hearing
Hearing Loss
/ virology
Humans
Infant
Infant, Newborn
Male
Predictive Value of Tests
Sustained Virologic Response
Thrombocytopenia
/ virology
Valganciclovir
/ therapeutic use
Viral Load
/ drug effects
antiviral therapy
congenital CMV infection
hearing loss
viral load
Journal
The Journal of infectious diseases
ISSN: 1537-6613
Titre abrégé: J Infect Dis
Pays: United States
ID NLM: 0413675
Informations de publication
Date de publication:
16 04 2019
16 04 2019
Historique:
received:
05
09
2018
accepted:
03
12
2018
pubmed:
12
12
2018
medline:
10
1
2020
entrez:
12
12
2018
Statut:
ppublish
Résumé
Viral loads (VLs) frequently are followed during treatment of symptomatic congenital cytomegalovirus disease, but their predictive value is unclear. Post hoc analysis of 2 antiviral studies was performed. Seventy-three subjects were treated for 6 weeks and 47 subjects were treated for 6 months. Whole blood VL was determined by real-time polymerase chain reaction before and during therapy. Higher baseline VL was associated with central nervous system involvement (3.82 log, range 1-5.65 vs 3.32 log, range 1-5.36; P = .001), thrombocytopenia (3.68 log, range 1-5.65 vs 3.43 log, range 1-5.36; P = .03), and transaminitis at presentation (3.73 log, range 1-5.60 vs 3.39 log, range 1-5.65; P = .009), but with overlap in the amount of virus detected between groups. In subjects treated for 6 months, lower VL at presentation correlated with better hearing outcomes at 12 months, but VL breakpoints predictive of hearing loss were not identified. Sustained viral suppression during 6 months of therapy correlated with better hearing outcomes at 6, 12, and 24 months (P = .01, P = .0007, P = .04), but a majority without viral suppression still had improved hearing. In infants with symptomatic congenital cytomegalovirus disease, higher whole blood VL before initiation of antiviral therapy has no clinically meaningful predictive value for long-term outcomes.
Sections du résumé
BACKGROUND
Viral loads (VLs) frequently are followed during treatment of symptomatic congenital cytomegalovirus disease, but their predictive value is unclear.
METHODS
Post hoc analysis of 2 antiviral studies was performed. Seventy-three subjects were treated for 6 weeks and 47 subjects were treated for 6 months. Whole blood VL was determined by real-time polymerase chain reaction before and during therapy.
RESULTS
Higher baseline VL was associated with central nervous system involvement (3.82 log, range 1-5.65 vs 3.32 log, range 1-5.36; P = .001), thrombocytopenia (3.68 log, range 1-5.65 vs 3.43 log, range 1-5.36; P = .03), and transaminitis at presentation (3.73 log, range 1-5.60 vs 3.39 log, range 1-5.65; P = .009), but with overlap in the amount of virus detected between groups. In subjects treated for 6 months, lower VL at presentation correlated with better hearing outcomes at 12 months, but VL breakpoints predictive of hearing loss were not identified. Sustained viral suppression during 6 months of therapy correlated with better hearing outcomes at 6, 12, and 24 months (P = .01, P = .0007, P = .04), but a majority without viral suppression still had improved hearing.
CONCLUSIONS
In infants with symptomatic congenital cytomegalovirus disease, higher whole blood VL before initiation of antiviral therapy has no clinically meaningful predictive value for long-term outcomes.
Identifiants
pubmed: 30535363
pii: 5232568
doi: 10.1093/infdis/jiy695
pmc: PMC6467187
doi:
Substances chimiques
Antiviral Agents
0
DNA, Viral
0
Valganciclovir
GCU97FKN3R
Ganciclovir
P9G3CKZ4P5
Types de publication
Clinical Trial, Phase I
Clinical Trial, Phase II
Clinical Trial, Phase III
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1398-1406Subventions
Organisme : NIAID NIH HHS
ID : K08 AI108691
Pays : United States
Organisme : NIAID NIH HHS
ID : N01AI30025
Pays : United States
Informations de copyright
© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
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