Prophylaxis Of Cytomegalovirus Infection Research Articles

Summary of the international consensus symposium on advances in the diagnosis, treatment and prophylaxis of cytomegalovirus infection

CMV infection and CMV disease can be difficult to differentiate and the diagnosis is usually based on a compatible clinical picture and the results of a diagnostic test for CMV. The only exception to this rule is in HIV-infected patients where fundoscopy is sufficient to diagnose CMV retinitis. Of the current diagnostic tests, qualitative and quantitative PCR, branched DNA and Hybrid Capture, are the most promising. The pp65 antigenemia assay has the disadvantage of being more labor-intensive than the DNA based tests. Preliminary data show that a positive qualitative PCR in a HIV-infected patient has a predictive value for the development of CMV retinitis. However, of the patients positive by qualitative PCR, those with high viral loads in quantitative PCR were at the greatest risk of CMV disease. This might make it possible to identify with great certainty the patients who will go on to develop CMV retinitis, thereby decreasing the number of patients eligible for preemptive or prophylactic therapy and increasing the cost-benefit of this therapeutic measure. Quantitative test might also be useful in monitoring response to therapy, but randomized trials comparing the test are needed. Prophylactic antiviral agents should not be used in seronegative transplant recipients receiving organs from seronegative donors. In high-risk transplant recipients, ganciclovir should be used. CMV vaccines are useful for the protection of babies from CMV seronegative mothers against congenital CMV disease. It also may be useful in seronegative transplant recipients receiving a seropositive donor organ, although the benefit of chemo prophylaxis may surpass that of vaccine. HIV-infected patients with CMV retinitis who relapse under either ganciclovir or foscarnet benefit from subsequent combination therapy, rather than switching to the other drug. However, the cost is high in terms of quality of life. Intravitreal therapy for CMV retinitis is very efficacious, suggesting that drug delivery is a problem in systemic therapy. However, intravitreal therapy does not protect against the development of CMV retinitis in the contralateral eye or from CMV disease elsewhere. Therefore, systemic therapy should be added. CMV disease of the CNS should be diagnosed early and treated agressively, possible with combination therapy. A diagnosis of CMV disease should be based on a compatible clinical picture and the demonstration of CMV in CSF by DNA or antigen assays which are more sensitive than culture.

A randomized controlled trial evaluating ganciclovir followed by high dose acyclovir versus high dose acyclovir in the prophylaxis of cytomegalovirus infection in liver transplantation

A randomized controlled trial evaluating ganciclovir followed by high dose acyclovir versus high dose acyclovir in the prophylaxis of cytomegalovirus infection in liver transplantation

Treatment and prophylaxis of cytomegalovirus infection after bone marrow transplantation.

Cytomegalovirus (CMV) is a ubiquitous human herpes virus (Fig. 1) that can cause primary infection, reactivated infection, or reinfection in recipients of blood components. CMV-associated interstitial pneumonia (IP) (Fig. 2) is the most common infectious cause of death following allogeneic bone marrow transplantation (BMT) for hematologic malignancies and, thus, is an important factor in limiting the success of this procedure (Neiman et al. 1977; Meyers et al. 1982a; Krowka et al. 1985; Cardozo et al. 1985).KeywordsBone Marrow TransplantationInterstitial PneumoniaCytomegalovirus InfectionBone Marrow Transplant RecipientCytomegalovirus PneumoniaThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Cytomegalovirus infection in acquired immune-deficiency syndrome.

Cytomegalovirus (CMV) infection is very common in acquired immune deficiency syndrome (AIDS) with approximately 40% of patients presenting CMV visceral involvement at advanced stage disease. The most common localizations are retinitis and gastrointestinal involvement; central nervous system disorders are likely to be underestimated. Diagnosis of CMV disease should be assessed, for all localizations except retinitis, on the association of clinical symptoms with presence of CMV inclusions in biopsy specimens. Two drugs, ganciclovir and foscarnet, are currently licensed for treatment. Both are administered intravenously. Since progression of CMV disease is very common particularly in retinitis, maintenance therapy should be given throughout remaining life. Unfortunately, maintenance therapy does not entirely prevent the risk of relapses. Drug toxicity is mainly bone marrow suppression with ganciclovir and renal insufficiency with foscarnet. Since quality of life is severely impaired by long-term daily intravenous treatment, orally active drugs are urgently needed both for treatment and primary prophylaxis of CMV infection.