This should only be ordered in patients who have rising plasma CMV viral loads after at least 3-4 weeks or more of anti-viral therapy. CMV viral loads commonly rise during the first 2-3 weeks of therapy but this does not indicate resistance unless the patient has had recent exposure to the specific drug.
Available Stat
No
Performing Lab
Viracor
Methodology
PCR, DNA sequencing
Reported
Set up Monday - Friday. Turnaround 4-6 days
Additional Information
Cytomegalovirus, also known as human herpesvirus 5, is a highly ubiquitous, double-stranded DNA virus in the Betaherpesvirinae subfamily. Serological studies have demonstrated that a majority of adults in the United States have been infected with CMV. Following primary infection, CMV establishes a lifelong latent infection, which may reactivate in both immunocompetent and immunocompromised individuals. In immunocompromised patients, primary or reactivated CMV infections can cause a range of symptoms like fever and fatigue and diseases that may include interstitial pneumonia, gastrointestinal infection, central nervous system disease, hepatitis, retinitis, and encephalitis. CMV reactivations have also been reported to occur frequently in critically ill immunocompetent patients and are associated with prolonged hospitalization or death. Due to the severity of these conditions and even life threatening outcomes, treatment of CMV diseases with antiviral drugs is common. Additionally, prophylactic treatment with antiviral drugs is used to prevent the occurrence of disease in high-risk patients. Anti-CMV drugs currently available for either treatment or prophylaxis include ganciclovir, valganciclovir (the orally administered prodrug), foscarnet, cidofovir, letermovir, and maribavir (Livtencity™). Maribavir targets UL97, and ganciclovir targets both UL97 and UL54. Cidofovir and foscarnet target UL54 alone. Letermovir, targets subunit 2 of the viral terminase complex, known as UL56. Viral UL97 phosphotransferase gene, and UL54 polymerase genotypic mutations are well documented mechanisms of resistance to these antiviral drugs.9 Mutations within UL56 have been shown to confer resistance to Letermovir. Drug resistance should be suspected if quantitative CMV PCR viral load values either persist or increase, or if CMV disease presents, after several weeks of treatment with an appropriate dose.
Synonyms
CMV
CMV susceptability
CID
CMV resistance
CMV inclusion disease
Sample Type
EDTA plasma
Collect
Lavender top
Amount to Collect
4 mL blood
Preferred Volume
2 mL plasma
Minimum Volume
1.5 mL plasma
Stability (from collection to initiation)
Room temperature 4 days, refrigerated 1 week, frozen at -20C 1 month
Rejection Criteria
CMV DNA concentrations too low to allow antiviral resistance testing (<1000 IU/mL for plasma)
Test Code
CMVAVR
Test Group
CMV
Sendout
Yes
Performing Lab
Viracor
Specimen Preparation
Separate plasma within 2 hours of collection and transfer to sterile screw-top plastic vial. Freeze plasma at -20C and ship to China Basin and ViraCor on dry ice.
Order ViraCor test # 33125
Contact the laboratory for authorization on anything other than plasma. Sequencing assays are very sensitive to inhibition, and processing of other sample types, including CSF and BAL, may be affected by PCR inhibitors that affect the result.
Preferred Volume
2 mL plasma
Minimum Volume
1.5 mL plasma
Rejection Criteria
CMV DNA concentrations too low to allow antiviral resistance testing (<1000 IU/mL for plasma)
Stability (from collection to initiation)
Room temperature 4 days, refrigerated 1 week, frozen at -20C 1 month
Additional Information
Cytomegalovirus, also known as human herpesvirus 5, is a highly ubiquitous, double-stranded DNA virus in the Betaherpesvirinae subfamily. Serological studies have demonstrated that a majority of adults in the United States have been infected with CMV. Following primary infection, CMV establishes a lifelong latent infection, which may reactivate in both immunocompetent and immunocompromised individuals. In immunocompromised patients, primary or reactivated CMV infections can cause a range of symptoms like fever and fatigue and diseases that may include interstitial pneumonia, gastrointestinal infection, central nervous system disease, hepatitis, retinitis, and encephalitis. CMV reactivations have also been reported to occur frequently in critically ill immunocompetent patients and are associated with prolonged hospitalization or death. Due to the severity of these conditions and even life threatening outcomes, treatment of CMV diseases with antiviral drugs is common. Additionally, prophylactic treatment with antiviral drugs is used to prevent the occurrence of disease in high-risk patients. Anti-CMV drugs currently available for either treatment or prophylaxis include ganciclovir, valganciclovir (the orally administered prodrug), foscarnet, cidofovir, letermovir, and maribavir (Livtencity™). Maribavir targets UL97, and ganciclovir targets both UL97 and UL54. Cidofovir and foscarnet target UL54 alone. Letermovir, targets subunit 2 of the viral terminase complex, known as UL56. Viral UL97 phosphotransferase gene, and UL54 polymerase genotypic mutations are well documented mechanisms of resistance to these antiviral drugs.9 Mutations within UL56 have been shown to confer resistance to Letermovir. Drug resistance should be suspected if quantitative CMV PCR viral load values either persist or increase, or if CMV disease presents, after several weeks of treatment with an appropriate dose.
CPT Codes
87910 x 2
LOINC Codes
40444-2
Available Stat
No
Ordering Recommendations
This should only be ordered in patients who have rising plasma CMV viral loads after at least 3-4 weeks or more of anti-viral therapy. CMV viral loads commonly rise during the first 2-3 weeks of therapy but this does not indicate resistance unless the patient has had recent exposure to the specific drug.
Test Code
CMVAVR
Test Group
CMV
Performing Lab
Viracor
Sendout
Yes
Methodology
PCR, DNA sequencing
Collect
Lavender top
Amount to Collect
4 mL blood
Sample Type
EDTA plasma
Preferred Volume
2 mL plasma
Minimum Volume
1.5 mL plasma
Rejection Criteria
CMV DNA concentrations too low to allow antiviral resistance testing (<1000 IU/mL for plasma)
Specimen Preparation
Separate plasma within 2 hours of collection and transfer to sterile screw-top plastic vial. Freeze plasma at -20C and ship to China Basin and ViraCor on dry ice.
Order ViraCor test # 33125
Contact the laboratory for authorization on anything other than plasma. Sequencing assays are very sensitive to inhibition, and processing of other sample types, including CSF and BAL, may be affected by PCR inhibitors that affect the result.
Synonyms
CMV
CMV susceptability
CID
CMV resistance
CMV inclusion disease
Stability (from collection to initiation)
Room temperature 4 days, refrigerated 1 week, frozen at -20C 1 month
Reported
Set up Monday - Friday. Turnaround 4-6 days
Additional Information
Cytomegalovirus, also known as human herpesvirus 5, is a highly ubiquitous, double-stranded DNA virus in the Betaherpesvirinae subfamily. Serological studies have demonstrated that a majority of adults in the United States have been infected with CMV. Following primary infection, CMV establishes a lifelong latent infection, which may reactivate in both immunocompetent and immunocompromised individuals. In immunocompromised patients, primary or reactivated CMV infections can cause a range of symptoms like fever and fatigue and diseases that may include interstitial pneumonia, gastrointestinal infection, central nervous system disease, hepatitis, retinitis, and encephalitis. CMV reactivations have also been reported to occur frequently in critically ill immunocompetent patients and are associated with prolonged hospitalization or death. Due to the severity of these conditions and even life threatening outcomes, treatment of CMV diseases with antiviral drugs is common. Additionally, prophylactic treatment with antiviral drugs is used to prevent the occurrence of disease in high-risk patients. Anti-CMV drugs currently available for either treatment or prophylaxis include ganciclovir, valganciclovir (the orally administered prodrug), foscarnet, cidofovir, letermovir, and maribavir (Livtencity™). Maribavir targets UL97, and ganciclovir targets both UL97 and UL54. Cidofovir and foscarnet target UL54 alone. Letermovir, targets subunit 2 of the viral terminase complex, known as UL56. Viral UL97 phosphotransferase gene, and UL54 polymerase genotypic mutations are well documented mechanisms of resistance to these antiviral drugs.9 Mutations within UL56 have been shown to confer resistance to Letermovir. Drug resistance should be suspected if quantitative CMV PCR viral load values either persist or increase, or if CMV disease presents, after several weeks of treatment with an appropriate dose.
CPT Codes
87910 x 2
LOINC Codes
40444-2
Ordering
Ordering Recommendations
This should only be ordered in patients who have rising plasma CMV viral loads after at least 3-4 weeks or more of anti-viral therapy. CMV viral loads commonly rise during the first 2-3 weeks of therapy but this does not indicate resistance unless the patient has had recent exposure to the specific drug.
Available Stat
No
Performing Lab
Viracor
Methodology
PCR, DNA sequencing
Reported
Set up Monday - Friday. Turnaround 4-6 days
Additional Information
Cytomegalovirus, also known as human herpesvirus 5, is a highly ubiquitous, double-stranded DNA virus in the Betaherpesvirinae subfamily. Serological studies have demonstrated that a majority of adults in the United States have been infected with CMV. Following primary infection, CMV establishes a lifelong latent infection, which may reactivate in both immunocompetent and immunocompromised individuals. In immunocompromised patients, primary or reactivated CMV infections can cause a range of symptoms like fever and fatigue and diseases that may include interstitial pneumonia, gastrointestinal infection, central nervous system disease, hepatitis, retinitis, and encephalitis. CMV reactivations have also been reported to occur frequently in critically ill immunocompetent patients and are associated with prolonged hospitalization or death. Due to the severity of these conditions and even life threatening outcomes, treatment of CMV diseases with antiviral drugs is common. Additionally, prophylactic treatment with antiviral drugs is used to prevent the occurrence of disease in high-risk patients. Anti-CMV drugs currently available for either treatment or prophylaxis include ganciclovir, valganciclovir (the orally administered prodrug), foscarnet, cidofovir, letermovir, and maribavir (Livtencity™). Maribavir targets UL97, and ganciclovir targets both UL97 and UL54. Cidofovir and foscarnet target UL54 alone. Letermovir, targets subunit 2 of the viral terminase complex, known as UL56. Viral UL97 phosphotransferase gene, and UL54 polymerase genotypic mutations are well documented mechanisms of resistance to these antiviral drugs.9 Mutations within UL56 have been shown to confer resistance to Letermovir. Drug resistance should be suspected if quantitative CMV PCR viral load values either persist or increase, or if CMV disease presents, after several weeks of treatment with an appropriate dose.
Synonyms
CMV
CMV susceptability
CID
CMV resistance
CMV inclusion disease
Collection
Sample Type
EDTA plasma
Collect
Lavender top
Amount to Collect
4 mL blood
Preferred Volume
2 mL plasma
Minimum Volume
1.5 mL plasma
Stability (from collection to initiation)
Room temperature 4 days, refrigerated 1 week, frozen at -20C 1 month
Rejection Criteria
CMV DNA concentrations too low to allow antiviral resistance testing (<1000 IU/mL for plasma)
Processing
Test Code
CMVAVR
Test Group
CMV
Sendout
Yes
Performing Lab
Viracor
Specimen Preparation
Separate plasma within 2 hours of collection and transfer to sterile screw-top plastic vial. Freeze plasma at -20C and ship to China Basin and ViraCor on dry ice.
Order ViraCor test # 33125
Contact the laboratory for authorization on anything other than plasma. Sequencing assays are very sensitive to inhibition, and processing of other sample types, including CSF and BAL, may be affected by PCR inhibitors that affect the result.
Preferred Volume
2 mL plasma
Minimum Volume
1.5 mL plasma
Rejection Criteria
CMV DNA concentrations too low to allow antiviral resistance testing (<1000 IU/mL for plasma)
Stability (from collection to initiation)
Room temperature 4 days, refrigerated 1 week, frozen at -20C 1 month
Result Interpretation
Additional Information
Cytomegalovirus, also known as human herpesvirus 5, is a highly ubiquitous, double-stranded DNA virus in the Betaherpesvirinae subfamily. Serological studies have demonstrated that a majority of adults in the United States have been infected with CMV. Following primary infection, CMV establishes a lifelong latent infection, which may reactivate in both immunocompetent and immunocompromised individuals. In immunocompromised patients, primary or reactivated CMV infections can cause a range of symptoms like fever and fatigue and diseases that may include interstitial pneumonia, gastrointestinal infection, central nervous system disease, hepatitis, retinitis, and encephalitis. CMV reactivations have also been reported to occur frequently in critically ill immunocompetent patients and are associated with prolonged hospitalization or death. Due to the severity of these conditions and even life threatening outcomes, treatment of CMV diseases with antiviral drugs is common. Additionally, prophylactic treatment with antiviral drugs is used to prevent the occurrence of disease in high-risk patients. Anti-CMV drugs currently available for either treatment or prophylaxis include ganciclovir, valganciclovir (the orally administered prodrug), foscarnet, cidofovir, letermovir, and maribavir (Livtencity™). Maribavir targets UL97, and ganciclovir targets both UL97 and UL54. Cidofovir and foscarnet target UL54 alone. Letermovir, targets subunit 2 of the viral terminase complex, known as UL56. Viral UL97 phosphotransferase gene, and UL54 polymerase genotypic mutations are well documented mechanisms of resistance to these antiviral drugs.9 Mutations within UL56 have been shown to confer resistance to Letermovir. Drug resistance should be suspected if quantitative CMV PCR viral load values either persist or increase, or if CMV disease presents, after several weeks of treatment with an appropriate dose.
Administrative
CPT Codes
87910 x 2
LOINC Codes
40444-2
Complete View
Available Stat
No
Ordering Recommendations
This should only be ordered in patients who have rising plasma CMV viral loads after at least 3-4 weeks or more of anti-viral therapy. CMV viral loads commonly rise during the first 2-3 weeks of therapy but this does not indicate resistance unless the patient has had recent exposure to the specific drug.
Test Code
CMVAVR
Test Group
CMV
Performing Lab
Viracor
Sendout
Yes
Methodology
PCR, DNA sequencing
Collect
Lavender top
Amount to Collect
4 mL blood
Sample Type
EDTA plasma
Preferred Volume
2 mL plasma
Minimum Volume
1.5 mL plasma
Rejection Criteria
CMV DNA concentrations too low to allow antiviral resistance testing (<1000 IU/mL for plasma)
Specimen Preparation
Separate plasma within 2 hours of collection and transfer to sterile screw-top plastic vial. Freeze plasma at -20C and ship to China Basin and ViraCor on dry ice.
Order ViraCor test # 33125
Contact the laboratory for authorization on anything other than plasma. Sequencing assays are very sensitive to inhibition, and processing of other sample types, including CSF and BAL, may be affected by PCR inhibitors that affect the result.
Synonyms
CMV
CMV susceptability
CID
CMV resistance
CMV inclusion disease
Stability (from collection to initiation)
Room temperature 4 days, refrigerated 1 week, frozen at -20C 1 month
Reported
Set up Monday - Friday. Turnaround 4-6 days
Additional Information
Cytomegalovirus, also known as human herpesvirus 5, is a highly ubiquitous, double-stranded DNA virus in the Betaherpesvirinae subfamily. Serological studies have demonstrated that a majority of adults in the United States have been infected with CMV. Following primary infection, CMV establishes a lifelong latent infection, which may reactivate in both immunocompetent and immunocompromised individuals. In immunocompromised patients, primary or reactivated CMV infections can cause a range of symptoms like fever and fatigue and diseases that may include interstitial pneumonia, gastrointestinal infection, central nervous system disease, hepatitis, retinitis, and encephalitis. CMV reactivations have also been reported to occur frequently in critically ill immunocompetent patients and are associated with prolonged hospitalization or death. Due to the severity of these conditions and even life threatening outcomes, treatment of CMV diseases with antiviral drugs is common. Additionally, prophylactic treatment with antiviral drugs is used to prevent the occurrence of disease in high-risk patients. Anti-CMV drugs currently available for either treatment or prophylaxis include ganciclovir, valganciclovir (the orally administered prodrug), foscarnet, cidofovir, letermovir, and maribavir (Livtencity™). Maribavir targets UL97, and ganciclovir targets both UL97 and UL54. Cidofovir and foscarnet target UL54 alone. Letermovir, targets subunit 2 of the viral terminase complex, known as UL56. Viral UL97 phosphotransferase gene, and UL54 polymerase genotypic mutations are well documented mechanisms of resistance to these antiviral drugs.9 Mutations within UL56 have been shown to confer resistance to Letermovir. Drug resistance should be suspected if quantitative CMV PCR viral load values either persist or increase, or if CMV disease presents, after several weeks of treatment with an appropriate dose.
