999The Role of Quantitative Blood PCR in the Management of Congenital Cytomegalovirus Infection
Bibliographic record
Abstract
Background. The role of quantitative blood PCR (qPCR) in the management of congenital CMV infection has not yet been determined. The objective of this study was to determine the time to undetectable viral load (uVL) among infants treated with oral valganciclovir (VGCV) for congenital CMV infection. Methods. All cases of congenital CMV diagnosed and treated between 2003 and 2013 at Centre Hospitalier Universitaire Sainte-Justine were identified retrospectively through the laboratory and clinical database. Cases were included for analysis if at least two blood qPCRs were done at any time after diagnosis while on treatment. CMV viral loads in QIAamp extracted DNA blood samples were estimated with an in-house qPCR method using TaqMan® MGB Hydrolysis probes/primers designed for UL83 gene and performed on a ABI 7500 platform. Treatment start time was at the discretion of the consultant physician, and treatment was stopped when qPCR became undetectable. Survival analysis was used to determine time to uVL and factors associated with a more rapid decline. Results. 27 cases of congenital CMV were identified during the study period. Among them, only 9 of the treated infants had follow-up qPCRs; 2 received sequential IV and oral therapy, 7 received oral VGCV alone. Mean dose of VGCV was 15.2 mg/kg/dose (range 8.7-17.1 mg/kg/dose). Median initial qPCR was 79 460 copies/ml (IQR 12 1333- 203 525), and mean time to uVL was 199 days (range 30-450 days). After 6 months of treatment, only 44% (95% CI 20.0-79.6) had achieved uVL. This increased to 70.4% at 9 months (95% CI 39.0-94.8) and 85% (95% CI 53.0-99.0) 12 months after treatment was started. Infants were more likely to attain uVL if their initial viral load was <100,000 copies/ml (HR 1.99, p = 0.51), initiated treatment at <7 days of life (HR 4.46, p = 0.18), and initiated sequential IV then oral vs oral therapy alone (HR 2.31, p = 0.36), though none of these differences were statistically significant. Conclusion. The use of serial qPCR may be a useful tool to monitor CMV disease activity and to guide treatment decisions in congenital CMV infection. Our results suggest that the recommended treatment duration of 6 weeks to 6 months may be too short to achieve an uVL in infants. Larger longitudinal studies are needed to confirm these findings, and to correlate viral load to clinical outcome. Disclosures. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".