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Open Access Research article

Relationship between pp65 antigenemia levels and real-time quantitative DNA PCR for Human Cytomegalovirus (HCMV) management in immunocompromised patients

Elisabetta Cariani2, Caterina P Pollara1*, Barbara Valloncini1, Francesca Perandin1, Carlo Bonfanti1 and Nino Manca1

Author Affiliations

1 Department of Experimental and Applied Medicine, Section of Microbiology, University of Brescia, and A.O. Spedali Civili, Brescia, Italy

2 Laboratorio di Patologia Clinica, Ospedale Civile S. Agostino-Estense, via Giardini 1355, 414041 Baggiovara (MO), Italy

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BMC Infectious Diseases 2007, 7:138  doi:10.1186/1471-2334-7-138

Published: 23 November 2007

Abstract

Background

Quantitative real-time PCR assays, which are more rapid and practical than pp65 antigenemia determination, are progressively becoming the preferred method for monitoring Human Cytomegalovirus (HCMV) reactivation. However, the relationship between HCMV DNA and antigenemia levels is still under investigation. The aim of this study was to analyse the relationship between HCMV DNA and pp65 antigenemia levels in order to identify clinically useful threshold values for the management of patients.

Methods

475 consecutive samples from 156 immunosuppressed patients were tested for HCMV by pp65 antigenemia and Real-time PCR assay.

Results

136 out of 475 consecutive samples derived from 48 patients showed evidence of HCMV infection. HCMV DNA was detected in 106 samples, pp65 antigen in 3, and both markers in 27. pp65 antigen detection was associated with higher HCMV DNA levels. The cut-off HCMV DNA level that best predicted pp65 antigenemia in this series of samples was 11,500 copies/ml, but different threshold levels could be observed for specific groups of patients. HCMV disease was observed in 5 out of 48 patients with active HCMV infection. The presence of clinical symptoms was associated with positive pp65 and with higher antigenemia levels. Higher HCMV DNA load at the onset of viral replication was correlated to the development of clinical symptoms.

Conclusion

Both pp65 antigenemia and HCMV DNA load can be useful for the prospective monitoring of immunocompromised subjects. Specific cut-off levels capable of triggering preemptive antiviral treatment should be determined in accordance to the type of test used and the characteristics of patients and prospectively validated.