Abstract
Human cytomegalovirus (HCMV) has a worldwide distribution, infecting between 40 and 90 % of adults, leading to lifelong latent infection. In solid organ and hematopoietic stem cell transplant recipients, HCMV is responsible for high morbidity from active infection with virus multiplication in blood to HCMV disease with organ defect. Pretransplant testing relies on donor and recipient CMV IgG serology whereas follow-up is based on viral load measurement in whole blood or plasma. As results of quantitative PCR assays are not comparable although use of international units, it is essential to follow-up the patients in the same laboratory. Therapeutic strategy relies on two options: prophylaxis or preemptive strategy. Over 3 log IU/mL, treatment with (val)ganciclovir, a polymerase inhibitor has to be initiated. In case of non-response, resistance testing and drug dosage have to be performed. If resistance is highlighted, foscarnet or cidofovir have to be initiated. As all these drugs have renal or hematological toxicity, new inhibitors targeting other steps of replication like maribavir or letermovir represent new hopes for prevention or treatment of HCMV in transplant recipients.
Published Version
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