Cytomegalovirus quantification: Where to next in optimising patient management?

Background: Over the years quantification of cytomegalovirus (HCMV) load in blood has become a mainstay of clinical management helping direct deployment of antiviral therapy, assess response to therapy and highlight cases of drug resistance. Aims: The review focuses on a brief historical perspective of HCMV quantification and the ways in which viral load is being used to improve patient management. Methods: A review of the published literature and also personal experience at the Royal Free Hospital. Results: Quantification of HCMV is essential for efficient patient management. The ability to use real time quantitative PCR to drive pre-emptive therapy has improved patient management after transplantation although the threshold viral loads for deployment differ between laboratories. The field would benefit from access to a universal standard for quantification. Conclusions: We see that HCMV quantification will continue to be central to delivering individualised patient management and facilitating multicentre trials of new antiviral agents and vaccines in a variety of clinical settings.