Author/Authors :
Sali Shahnaz نويسنده Infectious Diseases and Tropical Medicine Research Center Shahid Beheshti University of Medical Sciences,Tehran,IR Iran Sali Shahnaz , Arab-Mazar Zahra نويسنده Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Arab-Mazar Zahra , Soori Farhad نويسنده Infectious Diseases and Tropical Medicine Research Center,
Shahid Beheshti University of Medical Sciences, Tehran, IR
Iran
Abstract :
Background Cytomegalovirus (CMV) is one of the most frequently
encountered opportunistic viral pathogens in renal transplantation.
Approximately, in 60% of the transplant recipients CMV infection can be
observed and in > 20% symptomatic diseases can be developed.
However, antiviral prophylaxis and treatment have reduced the CMV
morbidity and mortality at the time of development of
antiviral-resistance CMV strains that can significantly contributed to
the adverse clinical outcomes in transplant recipients. Mutations in the
human CMV UL97 kinase gene are a major mechanism of
viral resistance to the anti-CMV drug “Ganciclovir (GCV)”. GCV, as the
most widely used and recognized therapy for CMV, is a substrate for the
UL97 kinase. Methods The studied patients were renal transplant
recipients in Tehran Labbafinejad hospital who were positive for CMV-DNA
PCR test and have been treated with Ganciclovire. Patients who have been
treated for at least 3 weeks with GCV and have not shown a proper
therapeutic response were candidate for UL97 gene
mutations associated with GCV resistance evaluation. Results About 60
patients with positive CMV DNA PCR were hospitalized during one year
study. Eventually, after 2 times measurement of CMV viral load at the
end of the third week and third month of therapy with Ganciclovire, 5
cases were candidate for antiviral resistance evaluation. Genotypic
testing was performed, but no mutation neither in
UL97 nor in UL 54 was detected by
the laboratory. Conclusions The increasing use of antiviral drugs in
transplant patients associated with the narrow range of antiviral agents
effective to treat CMV have increased our need for further understanding
of the risk factor for development of CMV antiviral resistance and it’s
clinical impacts. Detection of UL97 gene mutation
plays a major role to determine therapeutic strategies to treat patients
infected with the resistant viruses.
