Antiviral Resistance in Human Cytomegalovirus Due to UL54 Mutations Without UL97 Mutations
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Background: The concurrent detection of human cytomegalovirus (CMV) with UL97 andUL54 mutations is crucial for prescribing adequate antiviral treatment when drug-resistantCMV infection is suspected. We investigated the frequency of resistance-conferring mutationsamong patients with persistent or recurrent CMV infection and further reviewed thesubgroup with UL54 mutations without UL97 mutations. Methods: Patients with persistent or recurrent CMV infection after 4 weeks of treatment withganciclovir or foscarnet were consecutively enrolled between November 2012 and May 2019. The direct sequencing of UL97 and UL54 was performed to detect resistance mutations in CMV. Results: A total of 101 sequencing datasets were obtained from 65 enrolled patients. CMV UL97 and UL54 mutations were detected in 15.4% (10/65) and 9% (6/65) of patients,respectively. The CMV retrieved from two patients (3%) had mutations in both genes. Fourpatients with CMV UL54 mutations alone had a history of haploidentical peripheral bloodstem cell transplantation, and foscarnet was administered for over 4 weeks to these patients;21.5% of patients had suspected resistant CMV infection with either UL97 or UL54 mutations. Conclusion: In this study, CMV UL54 mutations but not UL97 mutations were found inpatients subjected to prolonged foscarnet administration for CMV disease.
Abstract
Background: The concurrent detection of human cytomegalovirus (CMV) with UL97 andUL54 mutations is crucial for prescribing adequate antiviral treatment when drug-resistantCMV infection is suspected. We investigated the frequency of resistance-conferring mutationsamong patients with persistent or recurrent CMV infection and further reviewed thesubgroup with UL54 mutations without UL97 mutations. Methods: Patients with persistent or recurrent CMV infection after 4 weeks of treatment withganciclovir or foscarnet were consecutively enrolled between November 2012 and May 2019. The direct sequencing of UL97 and UL54 was performed to detect resistance mutations in CMV. Results: A total of 101 sequencing datasets were obtained from 65 enrolled patients. CMV UL97 and UL54 mutations were detected in 15.4% (10/65) and 9% (6/65) of patients,respectively. The CMV retrieved from two patients (3%) had mutations in both genes. Fourpatients with CMV UL54 mutations alone had a history of haploidentical peripheral bloodstem cell transplantation, and foscarnet was administered for over 4 weeks to these patients;21.5% of patients had suspected resistant CMV infection with either UL97 or UL54 mutations. Conclusion: In this study, CMV UL54 mutations but not UL97 mutations were found inpatients subjected to prolonged foscarnet administration for CMV disease.
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