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Blood Viral Load in Symptomatic Congenital Cytomegalovirus Infection. J Infect Dis 2019 Apr 16;219(9):1398-1406

Date

12/12/2018

Pubmed ID

30535363

Pubmed Central ID

PMC6467187

DOI

10.1093/infdis/jiy695

Scopus ID

2-s2.0-85064994989 (requires institutional sign-in at Scopus site)   33 Citations

Abstract

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.

Author List

Marsico C, Aban I, Kuo H, James SH, Sanchez PJ, Ahmed A, Arav-Boger R, Michaels MG, Ashouri N, Englund JA, Estrada B, Jacobs RF, Romero JR, Sood SK, Whitworth S, Jester PM, Whitley RJ, Kimberlin DW, Collaborative Antiviral Study Group (CASG)

Author

Ravit Boger MD Chief, Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Administration, Intravenous
Administration, Oral
Antiviral Agents
Central Nervous System Diseases
Child Development
Cytomegalovirus
Cytomegalovirus Infections
DNA, Viral
Female
Ganciclovir
Hearing
Hearing Loss
Humans
Infant
Infant, Newborn
Male
Predictive Value of Tests
Sustained Virologic Response
Thrombocytopenia
Viral Load