Cytomegalovirus and ulcerative colitis: Place of antiviral therapy

• Published in: World journal of gastroenterology : WJG Vol. 22; no. 6; pp. 2030 - 2045
• Main Author: Pillet, Sylvie
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Co. Limited 14.02.2016; Baishideng Publishing Group Inc
• Subjects: Antiviral Agents - therapeutic use; Colitis, Ulcerative - diagnosis; Colitis, Ulcerative - drug therapy; Colitis, Ulcerative - immunology; Colon - drug effects; Colon - immunology; Colon - virology; Cytomegalovirus - drug effects; Cytomegalovirus - immunology; Cytomegalovirus - pathogenicity; Cytomegalovirus Infections - diagnosis; Cytomegalovirus Infections - drug therapy; Cytomegalovirus Infections - immunology; Cytomegalovirus Infections - virology; Ganciclovir - therapeutic use; Humans; Immunocompromised Host; Immunosuppressive Agents - adverse effects; Life Sciences; Microbiology and Parasitology; Opportunistic Infections - diagnosis; Opportunistic Infections - drug therapy; Opportunistic Infections - immunology; Opportunistic Infections - virology; Review; Risk Factors; Severity of Illness Index; Treatment Outcome; Viral Load; Virology; Virus Activation - drug effects; Inflammatory bowel disease; Ganciclovir; Flare-up; Quantitative polymerase chain reaction; Inflammation; Viral load; Intestinal mucosa; Human cytomegalovirus; Ulcerative colitis
• ISSN: 1007-9327; 2219-2840; 2219-2840
• DOI: 10.3748/wjg.v22.i6.2030

The link between cytomegalovirus (CMV) infection and inflammatory bowel diseases remains an important subject of debate. CMV infection is frequent in ulcerative colitis (UC) and has been shown to be potentially harmful. CMV reactivation needs to be diagnosed using methods that include in situ detection of viral markers by immunohistochemistry or by nucleic acid amplification techniques. Determination of the density of infection using quantitative tools (numbers of infected cells or copies of the genome) is particularly important. Although CMV reactivation can be considered as an innocent bystander in active flare-ups of refractory UC, an increasing number of studies suggest a deleterious role of CMV in this situation. The presence of colonic CMV infection is possibly linked to a decreased response to steroids and other immunosuppressive agents. Some treatments, notably steroids and cyclosporine A, have been shown to favor CMV reactivation, which seems not to be the case for therapies using anti-tumor necrosis factor drugs. According to these findings, in flare-ups of refractory UC, it is now recommended to look for the presence of CMV reactivation by using quantitative tools in colonic biopsies and to treat them with ganciclovir in cases of high viral load or severe disease.