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9/24/2018  |   11:15 AM - 11:45 AM   |  Diamond Ballroom I

The Use of CMV qPCR in the Blood as an Indicator for Treatment for Congenital CMV Infection

Background: Recent guidelines recommend antiviral treatment for moderate to severely symptomatic cases of cCMV infection. However, time from diagnosis to completion of all investigations to determine clinical severity can be long and costly, resulting in delays in treatment initiation. The objective of this study was to determine if baseline qPCR in the blood could identify infants who met treatment criteria according to the recent consensus classification. Methods: Retrospective study of children diagnosed with cCMV infection at CHU Sainte-Justine, Montreal, Canada, between 2008 and 2016, for whom CMV qPCR was done in the blood at baseline (<= 3 weeks of age) along with a complete diagnostic workup. Children were classified as moderate to severely symptomatic, mildly symptomatic, asymptomatic with isolated sensorineural hearing loss, or asymptomatic, and the association between CMV blood qPCR and clinical severity group was determined. Results: Forty-seven patients were included in the analysis; 31 cases (66%) were categorized as moderate-severely symptomatic, none mildly symptomatic, 4 (8.5%) asymptomatic with isolated hearing loss, and 12 (26%) asymptomatic. Median viral load was significantly higher among infants with moderate to severe disease vs. those asymptomatic or asymptomatic with isolated SNHL (13 736 vs. 1876 copies/ml, p=0.004), and again comparing infants with moderate to severe disease or asymptomatic with isolated SNHL vs. asymptomatic (17 736 vs. 1496 copies/ml, p<0.001). The probability of meeting treatment criteria (moderate to severe disease) was then determined using regression analysis. The risk of requiring treatment showed a sigmoidal shape from VL 1000 to 10 000 copies/ml, crossing the 50% probability at a level of 10 000 copies/ml, with a threshold of 100 000 copies/ml approaching a 100% probability of requiring treatment. Conclusion: These results suggest that baseline CMV blood qPCR could have a role in identifying infants who would benefit from antiviral therapy, pending a full diagnostic workup.

  • To understand the role of PCR in the diagnostic workup of cCMV infection
  • To determine whether the PCR value can reliably predict which infants will require treatment
  • To review the impact of this predictive value of PCR on screening programs

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Fatima Kakkar (Primary Presenter), fatima.kakkar@umontreal.ca;
Fatima Kakkar is a Paediatric infectious diseases specialist and clinician researcher at the University of Montreal, Sainte-Justine Hospital Center, and chair of the Canadian Paediatric and Perinatal AIDS research group. Her interests have expanded recently from paediatric HIV to other congenital infections, and specifically cCMV infection.

      ASHA DISCLOSURE:

Financial - No relevant financial relationship exists.

Nonfinancial - No relevant nonfinancial relationship exists.


      AAA DISCLOSURE:

Financial - No relevant financial relationship exists.




Mina Smiljkovic (Author,Co-Author), mina.m.smiljkovic@gmail.com;
Mina Smiljkovic is currently a paediatric infectious diseases fellow at the Hospital for Sick Children, working on the Sainte-Justine cCMV cohort as her research project through fellowship.

      ASHA DISCLOSURE:

Financial -

Nonfinancial -


      AAA DISCLOSURE:

Financial - No relevant financial relationship exists.




Christian Renaud (Author,Co-Author), christian.renaud@umontreal.ca;
Christian Renaud is a pediatric infectious diseases specialist and medical microbiologist, who specialises in paediatric virology.

      ASHA DISCLOSURE:

Financial -

Nonfinancial -


      AAA DISCLOSURE:

Financial - No relevant financial relationship exists.




Jean-Baptiste Lemeur (Co-Author), lemeur.jb@gmail.com;
Jean Baptiste is a doctoral student with expertise in biostatistics of infectious diseases.

      ASHA DISCLOSURE:

Financial -

Nonfinancial -


      AAA DISCLOSURE:

Financial - No relevant financial relationship exists.




Anne-Frédérique Minsart (Co-Author), afminsart@gmail.com;
Anne-Frederique is currently a fellow in Obstetrics and Gynecology working on cCMV infection as part of her research training objectives.

      ASHA DISCLOSURE:

Financial -

Nonfinancial -


      AAA DISCLOSURE:

Financial - No relevant financial relationship exists.




Isabelle Boucoiran (Co-Author), isabelle.boucoiran@umontreal.ca;
Isabelle Boucoiran is a maternofetal medicine and reproductive infectious disease specialist as well as a clinician scientist.

      ASHA DISCLOSURE:

Financial - No relevant financial relationship exists.

Nonfinancial - No relevant nonfinancial relationship exists.


      AAA DISCLOSURE:

Financial - Receives support from Canadian Institutes for Health Research.  




Bruce Tapiero (Co-Author), bruce.tapiero@umontreal.ca;
Bruce Tapiero is current head of the division of infectious diseases, and integral in the creation of the new center for perinatal infectious diseases at Sainte-Justine Hospital center, in Montreal

      ASHA DISCLOSURE:

Financial -

Nonfinancial -


      AAA DISCLOSURE:

Financial - No relevant financial relationship exists.




Valerie Lamarre (Co-Author), valerie.lamarre@umontreal.ca;
Valerie Lamarre is a pediatric infectious diseases specialist, focusing on perinatal infections in the province of Quebec.

      ASHA DISCLOSURE:

Financial -

Nonfinancial -


      AAA DISCLOSURE:

Financial - No relevant financial relationship exists.