Status and Future Management of Congenital Cytomegalovirus and Neonatal Herpes Simplex Virus Infections

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Congenital cytomegalovirus (CMV) and herpes simplex virus (HSV) infections are among the most common viral infections of the newborn in the developed world. CMV infections can cause sensorineural hearing loss, and both CMV and HSV infections can lead to impaired neurodevelopment. Diagnostic and treatment efforts have been investigated for the past 45 years. With the development of polymerase chain reaction (PCR) for diagnosis and its quantitation as well as studies of the pharmacokinetics and pharmacodynamics of ganciclovir/valganciclovir (CMV) and acyclovir (HSV), significant improvement in outcome has been achieved. For example, studies utilizing ganciclovir and valganciclovir demonstrate improved hearing and Bailey Developmental scores; however, therapy requires six months of treatment with valganciclovir. With neonatal HSV infections, high-dose acyclovir decreases mortality for two classifications of disease - encephalitis and disseminated multiorgan infection. Like congenital CMV infections, neonatal HSV requires long-term suppressive therapy following a course of IV acyclovir. Regardless, outcome for both diseases is unsatisfactory, and improved treatment approaches must be developed. The current review addresses these two members of the Herpesviridae family: the diseases they cause in the newborn, the current shortcomings and a consideration of future needs. Both viruses establish latency and are reactivated throughout an individual’s lifetime, ergo eradication at the present is impossible. The discussion is limited to these two life-threatening diseases. The successful lessons learned from combination therapies of human immunodeficiency virus and hepatitis C virus infections must be applied to these diseases. If improvement can be documented, it will have direct implications for managing diseases caused by both viruses in older individuals. It is the aim of the review to provide the reader with knowledge of the field, providing a reference to future needs and opportunities.