Detection of ganciclovir resistance after valacyclovir‐prophylaxis in renal transplant recipients with active cytomegalovirus infection

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Abstract
Whether valaciclovir (VCV) prophylaxis could be responsible for ganciclovir (GCV)‐resistance of Human cytomegalovirus (HCMV) in transplantation has never been documented. A multicentric retrospective pilot study was undertaken to detect GCV‐resistance through mutations within the UL97 gene in renal transplant recipients who experienced active HCMV infection and received valacyclovir prophylaxis. Twenty‐three patients who experienced HCMV antigenaemia or DNAemia during or at the end of prophylaxis were included. UL97 genotyping was carried out on peripheral blood samples, using a nested in‐house PCR, which amplified the full‐length UL97 gene. One patient has a resistance‐related mutation (M460I); the major risk factor for emergence of resistance in this patient was the presence of early and persistent antigenaemia. GCV‐resistance during VCV‐prophylaxis was rare after renal transplantation. However, special attention must be paid to patients developing early active HCMV infection under prophylaxis. J. Med. Virol. 73:566–573, 2004.