Understanding Viral Load Assays for Cytomegalovirus and Epstein-Barr Virus

EBV and Posttransplantation Lymphoproliferative Disorder

March 2010

Transplant patients with EBV infections are at risk for post-transplantation lymphoproliferative disorder, or PTLD, which can manifest anywhere along a spectrum of disease from mononucleosis-like symptoms to lymphoma.

PTLDs are caused by an abnormal proliferation of EBV-infected B cells, which result from the lack of adequate T-cell function that usually keep B-cell replication under control. Treatments or conditions that reduce T-cell function in the patient increase the risk for PTLD.

Although the mortality can be quite high, the incidence of PTLD is fairly low, and depends on factors such as the organ transplanted, age and seropositivity of the patient, and the type of immunosuppressive regimen.

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EBV and PTLD

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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?