Understanding Viral Load Assays for Cytomegalovirus and Epstein-Barr Virus

Interpreting Viral Loads

March 2010

The graph on the left is a theoretical example of 2 patients' viral load profiles plotted over time. Although we do not see any numbers on the Y axis, we can still make some interpretations from the trends that these viral loads show. Points to consider are the level of the first positive specimen, the highest viral load level detected, the rate of increase or decrease, and whether the patient is positive (and at what level) at the end of treatment. These variables, along with clinical presentation and other test results, can help a physician to determine: whether the patient might require a drug dosage adjustment, whether treatment should be extended, whether the virus might have become resistant to the medication, and estimate the risk recurrence of disease when the treatment ends.

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Interpreting Viral Loads

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Jump to section:

• Introduction
• Cytomegalovirus and Epstein-Barr Virus Background
• Patients and Immunosuppression
• CMV in Transplant Patients
• When to Treat CMV?
• CMV Treatment Strategies
• EBV and Posttransplantation Lymphoproliferative Disorder
• When to Treat EBV?
• Treatment for EBV Infection or PTLD
• The Balancing Act of Transplant Immunology
• The Balancing Act of Transplant Immunology: Less immunosuppression
• The Balancing Act of Transplant Immunology: More immunosuppression
• The Balancing Act of Transplant Immunology
• Crucial Questions
• Viral Load Assays
• Viral Load Assays, cont.
• Variability
• Ideal Standards
• Comparing Results
• Logarithmic (log) Processes
• Advantages of Logarithmic (log) Numbers
• Integer, Scientific Notation, Logarithm
• Log vs Fold
• Disadvantages of Log
• Remember These?
• System Precision/Imprecision
• What is Significant Change?
• Reality Check
• Literature is Helpful But...
• Interpreting Viral Loads
• Review
• References
• Questions?