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The value of CMV IgG avidity helps to interpret a positive result for CMV Tryptophan synthase IgM; the limits are that the kinetics of IgG avidity depend on the kit used and with some of these kits, the results may depend on CMV IgG concentration [30,31]. Recently, Revello et?al. [30] reported the results of a comparative evaluation of eight Conformit�� Europ��enne-marked CMV IgG avidity assays and concluded that commercial kit performances for IgG avidity determination are variable. In this study the time frames chosen for the disaggregation in three groups (6?months) do not allow a sound estimate of assay accuracy. The conclusions obtained on this panel may then be difficult to translate in practice and to compare with the results of previous studies and with the package inserts of commercial CMV IgG avidity assays. Moreover, dating the infection may be difficult in cases for which the ALK inhibitor IgG avidity index is reported as moderate/intermediate/grey-zone. Particular problems arise with large ranges of reference values of moderate avidity because the larger the range, the less specific the results are. In our experience using the Radim CMV IgG avidity assay (Cytomegalovirus IgG avidity EIA WELL; RADIM, Rome, Italy), moderate avidity results combined with specific CMV-IgM antibodies constitute a reliable marker of a recent primary infection especially when pregnant women are screened for CMV infection for the first time only after the first trimester and in the absence of previous serological data [22]. We tested 380 sera that were positive for CMV IgG and IgM collected from 380 pregnant women with ascertained primary CMV infections. Pregnant women were randomized into three groups. In the first group the primary CMV infection was diagnosed before 12?weeks of gestation and among the 99 pregnant women PI3K inhibitor cancer of this group, 70 had a low avidity and 29 a moderate avidity for CMV IgG, with 16 of the 70 (23%) and one of the 29 (3.4%) transmitting a congenital CMV infection to the newborn/fetus. In the second group, 240 primary CMV infections were diagnosed between 13 and 24?weeks of gestation: 180 of 240 pregnant women had a low avidity and 60 had a moderate IgG avidity index, with 57 of 180 (31.6%) and 14 of 60 (23.3%) transmitting congenital CMV infection to the newborn/fetus. Similar data were obtained in the third group, in whom the diagnosis of primary CMV infection was established after 24?weeks of gestation (T. Lazzarotto, unpublished data). Today, we believe that moderate CMV IgG avidity must be interpreted with caution and additional studies with other commercial CMV IgG avidity assays are urgently needed to understand the significance of IgG moderate/intermediate/grey-zone avidity in confirming the diagnosis of CMV primary infection during pregnancy. In 2004 Mac��et?al.