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P517 Features of cytomegalovirus infection in inflammatory bowel disease

Makarchuk P., Belousova E., Volchkova E., Kudriavtseva E.

Moscow Regional Clinical Research Institute, Moscow, Russian Federation

Background

To determine the relationship between frequency of cytomegalovirus infection (CMVI) and duration, severity and kind of treatment in IBD patients; to evaluate the rate of refractory disease in CMVI patients

Methods

During past 6 years 1652 inflammatory bowel disease (IBD) patients (ulcerative colitis – 1323, Crohn's disease – 329) were examined in Moscow region. CMVI was detected by PCR in blood and colon mucosa

Results

The percentage of CMVI in IBD patients increased from 0.6% in 2010 to 4.7% in 2015. In total CMVI was detected in 4.3% of IBD patients. Frequency of CMV among infected patients was different and depended on: a) the duration of IBD (Table 1), b) severity of IBD (Table 2), c) kind of treatment (Table 3).

Table 1

Duration of IBD$≤1$ year2–3 years$≥5$ years
Frequency of CMV10%19%35%

Table 2

Severity of IBDMildModerateSevere
Frequency of CMV0%37%63%

Table 3. Frequency of CMV, depending on the treatment

Kind of treatmentCMV (%), N=72
5-ASA5.6
GCS58.3
Azathioprine6.9
GCS + Azathioprine29.2
Infliximab/Infliximab + Azathioprine0%

The most of CMV cases were detected in patients treated with GCS (prednisone) and with combination of GCS+AZA. Refractory IBD was found in 51% of CMV infected patients (37 ptns). They were treated within gancyclovir during 2 weeks. As a result in 28 patients (75.6%) the sensitivity to base therapy wasrecovered. We called this fenomen “pseudo refractory” due to CMVI, which can be overcome with antiviral treatment.

Conclusion

In total CMVI occurs in 4.3% of IBD patients; most of CMVI occurs in IBD with duration ≥5 years and in moderate to severe patients. The most CMVI was found in IBD patients treated with GCS as mono- or combo therapy and frequency of refractory IBD was highest in the same groups. CMVI can simulate “pseudo refractory” IBD which can be overcome with antiviral treatment. We mandatory recommend to detect CMVI in IBD patients before GCS or immunosuppressants