Efficient Cytomegalovirus Detection AmongHaemodialysis Patients Through qPCR

One of the leading causes of death in Hemodialysis (HD) patients is Cytomegalovirus(CMV) infection. Quantitative PCR is considered as a highly sensitive method as itdetects small quantities of nucleic acid in various clinical samples. In Pakistan,nephrology units are not well developed and the investigations involved in normalencounter of viral infections in HD patients have been quite limited. Present study aimedto determine the prevalence of CMV infection, by ELISA and qPCR in patientsundergoing HD, in nephrology units in Pakistan. In this cross-sectional study total 150patients undergoing HD were included by non-probability convenience samplingtechnique, and those undergoing peritoneal dialysis were excluded. Blood specimen wascollected to estimate Hb, TLC, PLT count, bilirubin total, AST, ALT, ALP, urea,creatinine, uric acid and glucose levels. CMV IgM and IgG antibodies were detected byELISA method and CMV viral load by qPCR. Data was analyzed by using SPSS v.26.Mean of age was found to be 42.28±13.63 years, CMV IgM antibodies level=323±210AU/mL and CMV IgG antibodies level=311±182 AU/mL. Overall patients’ frequency ofmale was 66.7% and of female was 33.3%. Frequency of patients with positive CMV IgMlevel was 43.3%, positive CMV IgG level 72.0%, and positive for CMV viral load 82.7%.Prevalence of CMV IgM infection was higher in younger age (45.1% vs. 40.7%), males(45.0% vs. 40.0%), anemic males (46.0% vs. 38.5%), leukocytosis (55.6% vs. 50.0%),thrombocytopenia (32.0% vs. 18.2%). Prevalence of CMV IgG infection was also higherin younger age (74.7% vs. 67.8%), anemic males (73.6% vs. 61.5%), anemic females(73.2% vs. 66.7%), and leukocytosis (80.0% vs. 75.0%). Prevalence of CMV viral loadwas lower in younger age (81.3% vs. 84.7%, P-value 0.748); males (81.0% vs. 86.0%, Pvalue0.593); non-anemic males (76.9% vs. 81.6%, P-value 0.708), leukocytosis (93.3%vs. 100.0%, P-value 0.019), bilirubin total >1.0 (80.4% vs. 83.8%, and BSR (78.7% vs.88.5%, P-value 0.177). The study concluded that prevalence of positive CMV viral loadwas markedly higher than prevalence of CMV IgG positive cases and almost twice higherthan CMV IgM positive cases. Screening for CMV infection by commonly used ELISAmethod may give false negative results. Therefore, patients undergoing HD should bescreened by quantitative PCR in future.