#62 Resolution of thrombocytopenia during treatment for symptomatic congenital cytomegalovirus disease

Abstract

Abstract Background Congenital cytomegalovirus (cCMV) is the most common congenital viral infection in the United States (4.5 per 1000 live births) and is the leading non-genetic cause of sensorineural hearing loss and developmental disabilities in children worldwide. However, reliable estimates of time to resolution for manifestations of cCMV disease have not been fully elucidated. A better understanding of the resolution of laboratory abnormalities for cCMV is needed to guide decisions about frequency of platelet assessments following diagnosis and potentially optimize antiviral therapy. Method Data from 243 infants with symptomatic cCMV were retrospectively analyzed from four studies conducted by the NIH-funded Collaborative Antiviral Study Group over the years 1989-2011. Individuals were compared based on baseline platelet value, utilizing Division of AIDS Toxicity Scale categorization, and treatment received. Kinetics of the trend in platelets over time were compared between groups using Kaplan-Meier plots and binomial assessments of abnormal vs. normal. All analyses were conducted over the 6-week (45 day) time period. Results Predicted curves showed that the interaction between antiviral therapy and platelet value over time was found to be significant (p=0.0106) for individuals with normal baseline platelet counts (Grade 0, defined as ≥ 125,000). For individuals with Grades 1-4 thrombocytopenia at baseline, probability curves showed that both baseline grade (p=0.0006) and time (p<.0001) correlated with rate of resolution of thrombocytopenia, but antiviral treatment did not (p=0.1964). Kaplan-Meier plots of time to platelet count of ≥ 125,000 demonstrated that baseline platelet grade was significantly (p=0.0003) correlated with time to resolution of thrombocytopenia. Kaplan-Meier plots of time to platelet count of ≥ 100,000 demonstrated that baseline platelet grade was significantly (p=0.0056) correlated with time to Grade 1 thrombocytopenia. Conclusion For neonates with baseline thrombocytopenia from cCMV, antiviral therapy does not hasten time to resolution of thrombocytopenia. For neonates with normal baseline platelet values, antiviral therapy correlated with increasing platelet counts. Degree of baseline thrombocytopenia correlated with time to normalization of platelet count. Further understanding of the kinetics of resolution of laboratory abnormalities for symptomatic cCMV is needed to directly inform patient management decisions.