P0698 / #531: IS EARLY CIDOFOVIR ADMINISTRATION BENEFICIAL IN THE MANAGEMENT OF ADENOVIRUS INFECTION IN THE IMMUNOCOMPETENT CHILD? A CASE REPORT AND LITERATURE REVIEW.

Abstract

Aims & Objectives: Adenovirus causes self-limiting respiratory infections but is associated with mortality in the immunocompromised population, where the use of Cidofovir is well described. The mortality rate of severe adenovirus infection in immunocompetent children is reported as high as 15% but here the use and benefits of cidofovir are not well established. We describe a case of an immunocompetent 5-month-old infant with severe adenovirus infection and significant comorbidities who was successfully treated with Cidofovir. We also review supporting evidence of the use of Cidofovir for the immunocompetent child. Methods: We describe a recent case and undertake a systematic literature review to establish supporting evidence for the use of Cidofovir for the immunocompetent child with adenovirus infection. Results: A plethora of literature supports the use of cidofovir for children who are recipients of solid organ or stem cell transplants. There is minimal established evidence published demonstrating the effectiveness of Cidofovir for the immunocompetent child. There is a small cohort of published case studies and a retrospective study of young adults which demonstrate favorable clinical outcomes in the early use of Cidofovir. The potential for nephrotoxicity is well documented and may defer the decision to commence Cidofovir. However, evidence supports the use of lower dose cidofovir at a higher frequency where there is pre-existing renal disease. Conclusions: Our experience of the early use of Cidofovir supports the view that it may be beneficial for immunocompetent children with severe adenovirus infection. Review of the literature does not provide a universally accepted recommendation suggesting that further research is required.