Abstract Background Cytomegalovirus (CMV) is a latent herpesvirus that can reactivate under conditions of immunosuppression, a phenomenon of particular relevance in patients with inflammatory bowel disease (IBD). Its reactivation in ulcerative colitis (UC) has been associated with more severe disease forms, especially in corticosteroid-refractory cases with poorer clinical outcomes. Our objective was to evaluate the clinical impact of CMV infection in patients with UC and Crohn’s disease (CD) by analyzing its relationship with treatment modification, hospitalization risk and need for surgery. Methods A retrospective case–control study (2019–2023) was conducted on patients with UC and CD followed at Hospital Clinic Barcelona. Colon biopsies were assessed by histology and microbiology (PCR). Results A total of 209 patients were included, of whom 72 tested positive for CMV (34.4% by PCR, and only 7.2% by histology). All CMV-positive cases received antiviral therapy. CMV-positive UC patients had higher clinical activity scores (Mayo and UC PRO-2) (p 0.05) compared with CMV-negative controls, with no differences in endoscopic activity (Mayo subscore). In CD, CMV-positive cases had more liquid stools (p = 0.0448) compared with CMV-negative controls, but no differences in endoscopic severity (SES-CD). Erythrocyte sedimentation rate (ESR) was the only independent predictor of CMV positivity (OR = 1.028; p = 0.0006). Logistic regression analysis revealed a statistically significant association between CMV viral load and the probability of CMV-related hospitalization (p = 0.0363). CMV-positive patients required fewer treatment modifications (38.9% vs. 63.5%; p = 0.0007), with no significant differences in surgery or hospitalization rates during a median follow-up period of three years. Conclusion CMV infection is associated with greater clinical severity in UC, though not with increased endoscopic severity. Detection is more sensitive by PCR than by immunohistochemistry on paraffin-embedded tissue. Treatment of CMV infection (in both UC and CD) is associated with fewer changes in baseline IBD therapy. These findings support systematic CMV screening by PCR in moderate-to-severe flares to improve clinical management. References: - Kucharzik, T., Ellul, P., Greuter, T., Rahier, J. F. (2021). ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease. Journal of Crohn’s 14(10):1373-1379. doi:10.1002/ibd.20498 - Roblin X, Pillet S, Oussalah A, et al. Cytomegalovirus load in inflamed intestinal tissue is predictive of resistance to immunosuppressive therapy in ulcerative colitis. Am J Gastroenterol. 2011;106(11):2001-2008. doi:10.1038/ajg.2011.202 - Papadakis KA, Tung JK, Binder SW, et al. Outcome of cytomegalovirus infections in patients with inflammatory bowel disease. Am J Gastroenterol. 2001;96(7):2137-2142. doi:10.1111/j.1572-0241.2001.03949.x Conflict of interest: Dr. Garcia Solà, Clàudia: No conflict of interest Sepulveda, Rolando: No conflict of interest Fernandez Clotet, Agnes: None Caballol Oliva, Berta: No conflict of interest Gallego Barrero, Marta: No conflict of interest Baget, Rebeca: No conflict of interest Masamunt, Maria Carme: No conflict of interest Marcos, M Ángeles: No conflict of interest Bodro, Marta: No conflict of interest Cuatrecasas, Miriam: No conflict of interest Ricart Gomez, Elena: E. Ricart has received support for congress and conference attendance, speaker fees, research support or consulting fees from MSD, Abbvie, Ferring, Janssen, Otsuka, Pfizer, Takeda, Faes Farma, Galapagos/Alphasigma, Kern Pharma, Lilly, J & J, Dr Falk Pharma, and Fresenius-Kabi. Ordás Jiménez, Ingrid: I have received financial support for travel and educational activities, and have served as a speaker or advisory board member for the following companies AbbVie, MSD, Pfizer, Takeda, Janssen, Kern Pharma, Chiesi, Falk Pharma, and Faes Farma. I have also received research funding from AbbVie, Faes Farma, and Takeda.
Solà et al. (Thu,) studied this question.