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Clinical applications of interferon-γ releasing assays for cytomegalovirus to differentiate cytomegalovirus disease from bystander activation: a pilot proof-of-concept study.

Clinical applications of interferon-γ releasing assays for cytomegalovirus to differentiate cytomegalovirus disease from bystander activation: a pilot proof-of-concept study.
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Kim SH, Lee HS, Lee HJ, Kim SM, Shin S, Park SH, Kim KJ, Kim YH, Sung H, Lee SO, Choi SH, Yang SK, Kim YS, Woo JH, Han DJ,


Kim SH, Lee HS, Lee HJ, Kim SM, Shin S, Park SH, Kim KJ, Kim YH, Sung H, Lee SO, Choi SH, Yang SK, Kim YS, Woo JH, Han DJ, (click to view)

Kim SH, Lee HS, Lee HJ, Kim SM, Shin S, Park SH, Kim KJ, Kim YH, Sung H, Lee SO, Choi SH, Yang SK, Kim YS, Woo JH, Han DJ,

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The Korean journal of internal medicine 2017 08 23() doi 10.3904/kjim.2015.354

Abstract
Background/Aims
We evaluated the proposed clinical application of the combined interpretation of host factors and viral factors in two different cytomegalovirus (CMV) co-infection models.

Methods
We prospectively enrolled all human immunodeficiency virus non-infected patients with confirmed Pneumocystitis jirovecii pneumonia (PCP) and those with suspected gastrointestinal CMV disease in a tertiary hospital. All patients underwent CMV interferon-γ releasing assay (IGRA) for CMV (T-track CMV, Lophius Biosciences). We created the 2-axis model with the CMV IGRA results as the x-axis and the results for CMV virus replication as the y-axis, and hypothesized that cases falling in the left upper quadrant (high viral load and low CMV-specific immunity) of the model would be true CMV infections. The CMV IGRA results were concealed from the attending physicians.

Results
Of 39 patients with PCP, four (10%) were classified as combined CMV pneumonia, 13 (33%) as bystander activation, and the remaining 22 (56%) as no CMV infection. The data for all four patients with PCP and CMV pneumonia fell in the left upper quadrant of the 2-axis model. Of 24 patients with suspected gastrointestinal CMV disease, 12 (50%) were classified as gastrointestinal CMV disease and the remaining 12 (50%) as bystander activation with no gastrointestinal CMV disease. The data for 11 of the 12 patients (92%) with gastrointestinal CMV disease were located in the left upper quadrant of the 2-axis model.

Conclusions
Cases yielding low CMV IGRA results and high CMV viral replication appear to be true CMV infections. Further studies with large number of cases in different types of CMV disease should be proposed.

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