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( Sung-han Kim ),( Ho-su Lee ),( Hyun-jung Lee ),( Sun-mi Kim ),( Sung Shin ),( Sang-hyoung Park ),( Kyung-jo Kim ),( Young-hoon Kim ),( Heungsup Sung ),( Sang-oh Lee ),( Sang-ho Choi ),( Suk-kyun Yan 대한내과학회 2017 The Korean Journal of Internal Medicine Vol.32 No.5
Background/Aims: We evaluated the proposed clinical application of the com-bined interpretation of host factors and viral factors in two different cytomegalo-virus (CMV) co-infection models. Methods: We prospectively enrolled all human immunodeficiency virus non-in-fected patients with confirmed Pneumocystitis jirovecii pneumonia (PCP) and those with suspected gastrointestinal CMV disease in a tertiary hospital. All patients underwent CMV interferon-γ releasing assay (IGRA) for CMV (T-track CMV, Lophius Biosciences). We created the 2-axis model with the CMV IGRA results as the x-axis and the results for CMV virus replication as the y-axis, and hypoth-esized that cases falling in the left upper quadrant (high viral load and low CMV- specific immunity) of the model would be true CMV infections. The CMV IGRA results were concealed from the attending physicians. Results: Of 39 patients with PCP, four (10%) were classified as combined CMV pneumonia, 13 (33%) as bystander activation, and the remaining 22 (56%) as no CMV infection. The data for all four patients with PCP and CMV pneumonia fell in the left upper quadrant of the 2-axis model. Of 24 patients with suspected gas-trointestinal CMV disease, 12 (50%) were classified as gastrointestinal CMV dis-ease and the remaining 12 (50%) as bystander activation with no gastrointestinal CMV disease. The data for 11 of the 12 patients (92%) with gastrointestinal CMV disease were located in the left upper quadrant of the 2-axis model. Conclusions: Cases yielding low CMV IGRA results and high CMV viral repli-cation appear to be true CMV infections. Further studies with large number of cases in different types of CMV disease should be proposed.