Risk factors of cytomegalovirus reactivation in patients with rheumatic musculoskeletal diseases undergoing remission induction therapy with high-dose glucocorticoids; a prospective short-term cohort study.

Objective: To elucidate the risk factors of cytomegalovirus (CMV) infection and the involvement of immunity status in CMV infection in patients with rheumatic musculoskeletal disease during remission induction therapy.

Methods: Patients with rheumatic musculoskeletal disease who underwent induction therapy with high-dose glucocorticoids were consecutively enrolled. All patients were screened for CMV-IgG at baseline and monitored weekly for CMV pp65 antigen in polymorphonuclear leukocytes from peripheral blood until discharge. The titres of antibodies against individual viral antigens were examined using cell-based flow cytometry.

Results: A total of 157 patients (136 CMV-IgG-positive and 21 CMV-IgG-negative) were enrolled. CMV infection occurred in 52 (33.1%) patients, all of whom were CMV-IgG-positive (38.2% of CMV-IgG-positive patients). Multivariable analysis revealed that the initial prednisolone dose > 0.91 mg/kg/day (odds ratio [OR] 4.5, P < 0.01), intravenous cyclophosphamide (OR 3.3, P < 0.01), diabetes mellitus (OR 4.8, P = 0.01), and a history of malignancy (OR 2.6, P = 0.04) were independent relevant risk factors for CMV infection. While the titres of CMV-IgG and antibodies to individual CMV antigens were not significant for CMV infection, lymphocyte counts were significantly decreased from baseline to CMV infection (985/µL vs 622/µL, P = 0.03) in the CMV infection group treated with anti-CMV agents.

Conclusions: The risk factors for CMV infection short-term after the initiation of induction therapy in patients with rheumatic musculoskeletal diseases were treatment regimens and comorbidities. Decreased lymphocyte counts were more relevant than humoral immunity for CMV infection and the necessity of anti-CMV agents. Key Points • CMV infection during remission induction therapy was caused by reactivation of latent infection. • The risk factors for short-term CMV infection include treatment regimen and comorbidities. • Decreased lymphocyte counts is more relevant than humoral immunity in CMV infection and the necessity of anti-CMV agents.