Decreased Viral Load And Symptoms Of Polyomavirus-Associated Chronic Interstitial Cystitis After Intravesical Cidofovir Treatment

Main Category: Urology / Nephrology
Article Date: 14 Apr 2009 - 1:00 PDT

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UroToday.com - The role of reactivation of latent infection with the ubiquitous polyomaviruses in the causation of chronic interstitial cystitis has not yet been described. The polyomaviruses BK virus and JC virus are ubiquitous urinary tract colonizers in early life, but they rarely cause disease in immunocompetent individuals.

Polyomaviruses are excreted intermittently in the urine in healthy, asymptomatic adults. Dr. Damon Eisen and colleagues from Melbourne, Australia analyzed urinary polyomavirus shedding in hosts without severely compromised immune systems and with BPS/IC.

Two patients with cystoscopic appearances typical of BPS/IC were found to have persistent polyomavirus urinary infection through urinary cytological testing.

One patient was a 60-year-old white man who was relatively immunocompromised as a result of polyglandular autoimmune syndrome, manifested by type 1 diabetes, vitiligo, and pernicious anemia. He had a 4-year history of symptoms typical of BPS. Results of repeated urinary cytological analysis and quantitative PCR for polyomavirus DNA during a 10-month period showed evidence of polyomavirus infection with urinary viral loads greater than 108 copies/ml. A trial of intravesical cidofovir was begun resulting in resolution of symptoms and decrease in viral load that was sustained over 8 months.

A second patient, a 48-year-old Chinese woman with a 10-year history of BPS/IC symptoms and typical cystoscopic picture, had been treated with norfloxacin and had very low polyomavirus levels in the urine. Her symptoms gradually improved over 2 years of follow-up.

The authors note that serological evidence of BK virus is found in 85% of adults. Rates of urinary polyomavirus shedding may increase to 60% with pregnancy, older age, or immune dysfunction. Fluroquinolones appear to have anti-BKV activity. Further work is required to better define the role of polyomaviruses in BPS/IC pathogenesis. Dr. Eisen concludes that real-time studies will have the highest likelihood of demonstrating direct infection of the bladder. If additional evidence accumulates that shows BKV to be a cause of BPS/IC, further investigation of intravesical cidofovir would be warranted.

Eisen DP, Fraser IR, Sung LM, Finlay M, Bowden S, O'Connell H
Clin Infect Dis. 2009 May 1;48(9):e86-8
10.1086/597827

Written by UroToday.com Contributing Editor Philip M. Hanno, MD, MPH

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