Inflammatory Bowel Disease Patients With High-Grade Cytomegalovirus Infection May Benefit From Antiviral Therapy

Abstract

Introduction: Patients with inflammatory bowel disease (IBD) have an increased risk of cytomegalovirus (CMV) colitis, but can also have incidental CMV identified on mucosal biopsies. Identifying IBD patients with CMV who may benefit from antiviral therapy thus remains a challenge. Increasing evidence support that patients with a “higher grade” of CMV infection may benefit most from antiviral therapy, but there is no consensus in defining high versus low grade infection. We aim to investigate the effect of antiviral treatment in high and low grade infection by CMV cell number. Methods: Patients with IBD and CMV infection were identified by searching the pathology database. Slides were re-reviewed blinded to clinical outcome and the number of CMV cells on immunohistochemical (IHC) staining was quantified. The distribution of CMV cell counts were determined, and patients were stratified into “high grade” and “low grade” infection, based on the median cell number (high grade: > median, low grade: < median). Charts were reviewed for clinical outcomes and laboratory data including serum CMV PCR. Results: Forty-four patients with IBD and CMV by IHC were identified. Cell count ranged from 1 to 25 cells (median 5); high grade infection was defined as ≥5 cells. Serum CMV polymerase chain reaction (PCR) was significantly higher in patients with high vs low grade infection (167 vs 16 copies, p < 0.05). There were no differences in hospitalization rate, length of stay, and inflammatory markers between high and low grade infection, and between treated versus untreated subgroups (Table 1). Although not statistically significant, there was decreased colectomy rate in patients with high CMV load receiving antiviral treatment, compared to patients not receiving treatment (Table 1). The colectomy rates of treated versus untreated patients with low grade CMV appear to be similar.Table 1Conclusion: Our study indicates that serum CMV PCR correlates with colonic CMV burden and may be used to predict CMV colitis with “high grade” CMV infection. Our data suggests that treating patients with high CMV burden (≥5 CMV inclusion cells) may improve important clinical outcomes, notably colectomy. Further studies are warranted.