Clinical experience with a novel assay measuring cytomegalovirus (CMV)-specific CD4+ and CD8+ T-cell immunity by flow cytometry and intracellular cytokine staining to predict clinically significant CMV events.

Autor: Rogers R; Division of Infectious Diseases, Department of Internal Medicine, Warren Alpert Medical School of Brown University, 593 Eddy Street, Gerry House 111, Providence, RI, 02903, USA., Saharia K; Division of Infectious Diseases and Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA., Chandorkar A; Division of Infectious Diseases and Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA., Weiss ZF; Division of Infectious Diseases, Department of Internal Medicine, Warren Alpert Medical School of Brown University, 593 Eddy Street, Gerry House 111, Providence, RI, 02903, USA.; Division of Infectious Diseases, Department of Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Vieira K; Division of Infectious Diseases, Department of Internal Medicine, Warren Alpert Medical School of Brown University, 593 Eddy Street, Gerry House 111, Providence, RI, 02903, USA., Koo S; Division of Infectious Diseases, Department of Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Farmakiotis D; Division of Infectious Diseases, Department of Internal Medicine, Warren Alpert Medical School of Brown University, 593 Eddy Street, Gerry House 111, Providence, RI, 02903, USA. dimitrios.farmakiotis@lifespan.org.
Jazyk: angličtina
Zdroj: BMC infectious diseases [BMC Infect Dis] 2020 Jan 17; Vol. 20 (1), pp. 58. Date of Electronic Publication: 2020 Jan 17.
DOI: 10.1186/s12879-020-4787-4
Abstrakt: Background: Cytomegalovirus (CMV) infection is one of the most common opportunistic infections following organ transplantation, despite administration of CMV prophylaxis. CMV-specific T-cell immunity (TCI) has been associated with reduced rates of CMV infection. We describe for the first time clinical experience using the CMV T-Cell Immunity Panel (CMV-TCIP), a commercially available assay which measures CMV-specific CD4+ and CD8+ T-cell responses, to predict clinically significant CMV events.
Methods: Adult (> 18-year-old) patients with CMV-TCIP results and ≥ 1 subsequent assessment for CMV DNAemia were included at Brown University and the University of Maryland Medical Center-affiliated hospitals between 4/2017 and 5/2019. A clinically significant CMV event was defined as CMV DNAemia prompting initiation of treatment. We excluded indeterminate results, mostly due to background positivity, allogeneic hematopoetic cell transplant (HCT) recipients, or patients who were continued on antiviral therapy against CMV irrespective of the CMV-TCIP result, because ongoing antiviral therapy could prevent a CMV event.
Results: We analyzed 44 samples from 37 patients: 31 were solid organ transplant recipients, 4 had hematologic malignancies, 2 had autoimmune disorders. The CMV-protection receiver operating characteristic (ROC) area under the curve (AUC) was significant for %CMV-specific CD4+ (AUC: 0.78, P < 0.001) and borderline for CD8+ (AUC: 0.66, P = 0.064) T-cells. At a cut-off value of 0.22% CMV-specific CD4+ T-cells, positive predictive value (PPV) for protection against CMV was 85% (95%CI 65-96%), and negative predictive value (NPV) was 67% (95%CI 41-87%).
Conclusions: The CMV-TCIP, in particular %CMV-specific CD4+ T-cells, showed good diagnostic performance to predict CMV events. The CMV-TCIP may be a useful test in clinical practice, and merits further validation in larger prospective studies.
Databáze: MEDLINE
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