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. 2013 Jul;74(1):84-90.
doi: 10.1002/ana.23893. Epub 2013 Aug 6.

JC virus antibody status underestimates infection rates

Joseph R Berger  1 , Sidney A Houff, Julie Gurwell, Nubia Vega, Craig S Miller, Robert J Danaher
Affiliations

JC virus antibody status underestimates infection rates

Joseph R Berger et al. Ann Neurol. 2013 Jul.

Abstract

Objective: JC virus (JCV) seropositivity is a risk factor for progressive multifocal leukoencephalopathy (PML) in patients on natalizumab. Accordingly, the JCV serological antibody test is of paramount importance in determining disease risk.

Methods: We tested the accuracy of the JCV serum antibody test by comparing the results of JCV serology to JCV viruria and viremia in 67 patients enrolled in a single-center, retrospective cohort study. Bodily fluids (urine and blood) were assessed for JCV DNA by real time quantitative polymerase chain reaction 6 to 47 months (mean = 26.1 months) before JCV antibody testing. In 10 individuals, blood and urine samples were obtained on 2 separate occasions at 6-month intervals.

Results: Forty (59.7%) of the 67 patients were JCV seropositive. Of 27 JCV seronegative patients, 10 (37%) had JCV viruria. Urine JCV DNA copy numbers were significantly higher in the seropositive group (mean log copy number = 5.93, range = 1.85-9.21) than the seronegative group (mean log copy number = 2.41, range = 1.85-5.43; p = 0.0026). Considering all body fluid test results, 50 (74.6%) of the 67 patients were previously infected with JCV.

Interpretation: The false-negative rate of the JCV serology in this study was 37%; therefore, JCV serostatus does not appear to identify all patients infected with JCV. Thus, a negative JCV antibody result should not be conflated with absence of JCV infection. This discordance may be important in understanding JCV biology, risk for PML, and PML pathogenesis.

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Figures

Figure 1
Figure 1
Comparison of JC virus antibody status in serum versus JC virus DNA status in urine. * - Not all patients provided urine at study visit.
Figure 2
Figure 2
Log10 values of urine virus in the JC virus antibody negative and positive groups
JCV antibody negative population (n=10)JCV antibody positive population (n=23)
 Mean log10 value = 2.657 Mean log10 value = 5.968
 Median log10 value = 2.2385(line) Median log10 value = 6.991 (line)
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