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Ariadna Clos-Parals, Paula Rodríguez-Martínez, Fiorella Cañete, Míriam Mañosa, Alejandra Ruiz-Cerulla, Mª José Paúles, Jordina Llaó, Jordi Gordillo, Caterina Fumagalli, Esther Garcia-Planella, Isabel Ojanguren, Eduard Cabré, Jordi Guardiola, Eugeni Domènech, Prognostic Value of the Burden of Cytomegalovirus Colonic Reactivation Evaluated by Immunohistochemical Staining in Patients with Active Ulcerative Colitis, Journal of Crohn's and Colitis, Volume 13, Issue 3, March 2019, Pages 385–388, https://doi.org/10.1093/ecco-jcc/jjy173
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Abstract
Colonic cytomegalovirus [CMV] reactivation has been involved in steroid refractoriness in patients with active ulcerative colitis [UC]. The benefits of antiviral therapy in this clinical setting are still under debate, but the burden of viral reactivation has been associated with a poorer outcome in some studies. Our aim was to assess whether the burden of CMV reactivation measured by the number of viral inclusions by immunohistochemistry [IHC-CMV] is associated with a risk of colectomy.
Biopsy sets of UC patients with positive IHC-CMV were identified from the Pathology departments of three university hospitals. All biopsies were reviewed by expert pathologists, and the maximum number of IHC-CMV–positive cells in each biopsy set was re-assessed. Epidemiological and clinical features and clinical outcomes were recorded.
Forty-six positive IHC-CMV cases with UC were included. At the time of CMV reactivation, 70% were receiving corticosteroids, 33% azathioprine, and 24% anti–tumour necrosis factor [TNF] agents. Thirty-two patients [70%] were treated with antiviral therapy. The median number of IHC-CMV–positive cells was 2 cells/biopsy [IQR 1–4]. Fourteen patients [30%] underwent colectomy, and 4 of them [29%] showed persistence of CMV in the surgical specimen. In the multivariate analysis, colectomy was only associated with >2 positive cells/biopsy [p = 0.048] and younger age [p = 0.023].
The burden of CMV colonic reactivation in patients with active UC, as measured by IHC, seems to be related to the risk of colectomy, and more data is needed to understand whether antiviral therapy guided by CMV burden will alter the clinical outcome.
