January 28, 2013

The Time Course of Development and Impact From Viral Resistance Against Ganciclovir in Cytomegalovirus Infection.


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The authors conducted a study of ganciclovir resistant mutations (GRM) of the UL97 gene in a cohort of 99 SOT recipients who were diagnosed with a first episode of CMV infection. GRMs were defined as ‘signature’ if the mutant/wildtype ganciclovir IC50 ratio was >2 and ‘polymorphic’ if this ratio was <2. Polymorphic GRMs were detected during the first CMV episode in 21/99 patients. No signature GRMs were detected in the first CMV episode. However, 7/19 recurrences had a signature GRM. The presence of a signature GRM was associated with ganciclovir treatment failure whereas a polymorphic GRM did not affect the risk of treatment failure. The study implies that patients failing ganciclovir treatment, may have a signature ganciclovir mutation present. Thus it would be important to do CMV drug resistance testing in patients who are not responding to treatment. Since most centers do not have ganciclovir resistance testing in real-time, clinical decisions will need to be made regarding change of therapy. However, knowledge of resistant mutations will be beneficial in the longer term management of the patient.

Transplant Infectious Disease

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