[Evaluate the host cellular immune response to better prevent and diagnose viral infections]

In medicine, virological diagnosis is mainly based on the detection of the viral genome and antigens, or on the identification of specific antibodies produced in response to infection. These strategies are suitable for characterizing an active infection or past contact with an already known virus. The recent development of tests for evaluating the host's cellular immune response opens new perspectives for personalized patient care based on immunomonitoring. The IGRA tests (Interferon Gamma Release Assay), measuring interferon gamma produced by T lymphocytes stimulated in vitro by antigenic peptides specific to infectious agents, and the quantification of the blood viral load of Torque teno virus (TTV) thus constitute tools for assessing infectious risk, particularly usable to predict opportunistic viral reactivations in immunocompromised patients. The characterization of the expression profile of interferon stimulated genes in a respiratory sample is also likely to provide significant assistance in diagnosis, discriminating a viral infection from a bacterial infection, an acute infection from a persistence of nucleic acids from non replicating microorganisms or allowing, in case of viral emergence, to quickly identify infected subjects in the absence of specific PCR tests available. All of these new approaches, described in this review, have the potential to considerably improve patient care with the objective to correctly prescribe medical virology tests and anti-infective treatments.