Cytomegalowirus – Zapobieganie i profilaktyka

Cytomegalowirus
Zapobieganie i profilaktyka

Cytomegalowirus (CMV) stanowi istotne zagrożenie zakażeniem oportunistycznym u pacjentów po transplantacji narządów oraz u osób z obniżoną odpornością. Profilaktyka CMV opiera się na dwóch głównych strategiach: profilaktyce uniwersalnej, polegającej na podawaniu leków przeciwwirusowych (np. valgancyklowiru w dawce 900 mg raz dziennie przez 3-6 miesięcy lub dłużej) wszystkim pacjentom z grup ryzyka, oraz strategii wyprzedzającej, opartej na monitorowaniu wiremii CMV i szybkim wdrożeniu leczenia (np. valgancyklowir 900 mg dwa razy dziennie po wykryciu wiremii). Valgancyklowir jest lekiem pierwszego wyboru, jednak jego stosowanie wiąże się z ryzykiem mielosupresji (leukopenia, neutropenia). Alternatywą jest letermowir (480 mg raz dziennie, 240 mg przy jednoczesnym stosowaniu cyklosporyny), który charakteryzuje się korzystniejszym profilem bezpieczeństwa, szczególnie u pacjentów z ryzykiem mielosupresji. Profilaktyka powinna być dostosowana do ryzyka pacjenta, uwzględniając serostatus dawcy i biorcy (np. D+/R- wymaga dłuższej profilaktyki), typ przeszczepu oraz intensywność immunosupresji.

Profilaktyka zakażeń cytomegalowirusem (CMV)

Cytomegalowirus (CMV) pozostaje jednym z najczęstszych zakażeń oportunistycznych u pacjentów poddawanych transplantacji narządów oraz u osób z obniżoną odpornością. W ostatnich latach pojawiło się kilka nowych strategii zapobiegania zakażeniom CMV, które mają na celu zmniejszenie ryzyka wystąpienia choroby związanej z tym wirusem¹. Istnieją dwa główne podejścia do profilaktyki: profilaktyka uniwersalna (powszechna) oraz strategia wyprzedzająca (preemptive therapy), które różnią się zarówno pod względem skuteczności, jak i profilu bezpieczeństwa¹².

Strategie profilaktyki CMV

Dwie główne strategie profilaktyki CMV obejmują:

Profilaktykę uniwersalną – polega na podawaniu leków przeciwwirusowych wszystkim pacjentom z grupy ryzyka od momentu transplantacji przez określony czas (zazwyczaj 3-6 miesięcy po transplantacji lub dłużej)¹³
Strategię wyprzedzającą (preemptive therapy) – opiera się na ścisłym monitorowaniu wiremii CMV i szybkim rozpoczęciu leczenia przeciwwirusowego w przypadku wykrycia wirusa, zanim pojawią się objawy kliniczne⁴²

Obie te strategie mają zalety i wady. Profilaktyka uniwersalna zapobiega wczesnej wiremii CMV i może poprawiać długoterminowe wyniki przeszczepu, ale wiąże się z mielotoksycznością, zwiększonymi kosztami i większym ryzykiem późnego wystąpienia choroby CMV⁵. Z drugiej strony, strategia wyprzedzająca wymaga regularnego monitorowania i może prowadzić do rzadszego występowania późnego zakażenia CMV, a także wiąże się z mniejszym ryzykiem działań niepożądanych związanych z lekami⁶.

Grupy ryzyka zakażenia CMV

Ryzyko zakażenia CMV jest szczególnie wysokie w następujących grupach pacjentów:

Biorcy przeszczepów narządów, szczególnie gdy dawca jest seropozytywny, a biorca seronegatywny (D+/R-)³⁷
Biorcy przeszczepów płuc, jelit i złożonych przeszczepów tkankowych⁴
Pacjenci poddawani allogenicznemu przeszczepieniu komórek macierzystych (HSCT)⁸
Osoby z HIV/AIDS z liczbą komórek CD4+ poniżej 100 komórek/mm3⁹
Pacjenci otrzymujący intensywną immunosupresję, w tym leczenie przeciwciałami przeciwlimfocytarnymi¹⁰

Leki stosowane w profilaktyce CMV

W profilaktyce zakażeń CMV stosuje się różne leki przeciwwirusowe. Wybór leku zależy od czynników ryzyka pacjenta, rodzaju transplantacji oraz strategii profilaktycznej¹¹.

Valgancyklowir

Valgancyklowir (Valcyte) jest obecnie preferowanym lekiem w profilaktyce uniwersalnej⁴. Jest to prolek gancyklowiru, który konkuruje z trifosforanem deoksyguanozyny o wiązanie z wirusową polimerazą DNA, hamując w ten sposób syntezę DNA wirusa¹². Najczęściej stosowana dawka to 900 mg raz dziennie, dostosowana do funkcji nerek¹³.

Valgancyklowir jest również stosowany w strategii wyprzedzającej, gdzie podaje się go w dawce 900 mg dwa razy dziennie po wykryciu wiremii CMV⁴. Głównym działaniem niepożądanym valgancyklowiru jest mielosupresja, szczególnie leukopenia i neutropenia¹⁴.

Letermowir

Letermowir (Prevymis) jest nowszym lekiem przeciwwirusowym, który działa poprzez hamowanie kompleksu terminazy CMV⁷. Jest zatwierdzony przez FDA do profilaktyki CMV u dorosłych biorców seropozytywnych allogenicznego przeszczepu komórek macierzystych (HSCT) oraz u biorców przeszczepów nerki z wysokim ryzykiem (D+/R-)¹⁵.

Letermowir wykazuje korzystny profil bezpieczeństwa, z niskim ryzykiem mielosupresji i nefrotoksyczności w porównaniu do valgancyklowiru¹⁶. Zalecana dawka to 480 mg raz dziennie doustnie lub dożylnie (240 mg przy jednoczesnym stosowaniu cyklosporyny)¹⁷. Letermowir jest szczególnie przydatny u pacjentów, którzy nie tolerują valgancyklowiru z powodu leukopenii¹⁸.

Lek	Dawkowanie	Wskazania	Główne działania niepożądane
Valgancyklowir (Valcyte)	900 mg raz dziennie (profilaktyka) 900 mg dwa razy dziennie (leczenie)	Profilaktyka uniwersalna i strategia wyprzedzająca	Leukopenia, neutropenia, niedokrwistość
Letermowir (Prevymis)	480 mg raz dziennie 240 mg raz dziennie (z cyklosporyną)	Profilaktyka u biorców HSCT i przeszczepów nerki (D+/R-)	Nudności, biegunka, rzadko mielosupresja
Gancyklowir	5 mg/kg co 12h dożylnie	Leczenie inwazyjnego CMV, profilaktyka	Neutropenia, trombocytopenia
Acyklowir (wysokie dawki)	800 mg 4-5 razy dziennie	Alternatywna profilaktyka u pacjentów HSCT	Nefrotoksyczność, zaburzenia neuropsychiatryczne
Walacyklowir	2 g co 6 godzin	Alternatywa dla valgancyklowiru w profilaktyce	Nudności, bóle głowy, mniej mielosupresji niż valgancyklowir
Immunoglobulina anty-CMV	Zgodnie z protokołem	Dodatkowa ochrona, szczególnie u biorców przeszczepu płuc	Reakcje związane z infuzją, gorączka

Inne leki przeciwwirusowe

Inne leki stosowane w profilaktyce CMV obejmują:

Gancyklowir – stosowany dożylnie, zwłaszcza u pacjentów, którzy nie mogą przyjmować leków doustnie¹⁰
Walacyklowir – alternatywa dla valgancyklowiru, wykazująca podobną skuteczność w zapobieganiu chorobie CMV, ale niższe ryzyko leukopenii¹⁴
Acyklowir w wysokich dawkach – może być stosowany w profilaktyce CMV u biorców HSCT, zwłaszcza gdy letermowir jest niedostępny¹⁹
Foskarnet – stosowany w przypadku oporności na gancyklowir, ale ma znaczną nefrotoksyczność¹²

Immunoglobulina przeciw CMV

Immunoglobulina przeciw cytomegalowirusowi (CMV-IG, Cytogam) jest preparatem immunoglobulin pochodzących z puli zdrowych dawców z wysokimi mianami przeciwciał przeciwko CMV¹⁵. Może być stosowana jako dodatkowa ochrona, szczególnie u biorców przeszczepów płuc, chociaż dane dotyczące jej skuteczności w zapobieganiu chorobie CMV są ograniczone⁴²⁰.

Korzyści z dodania CMV-IG do skutecznych leków przeciwwirusowych w profilaktyce CMV po przeszczepieniu narządów miąższowych są dyskusyjne, a dowody potwierdzające jej skuteczność są ograniczone²⁰.

Profilaktyka CMV w różnych grupach pacjentów

Biorcy przeszczepów narządów miąższowych

Amerykańskie Towarzystwo Transplantacyjne ustaliło kategorie ryzyka dla profilaktyki CMV po przeszczepieniu narządów miąższowych (SOT) na podstawie serologii dawców i biorców³:

D+/R- (dawca seropozytywny/biorca seronegatywny) – najwyższe ryzyko, zalecana profilaktyka przeciwwirusowa przez 3-6 miesięcy, szczególnie u biorców przeszczepu wątroby, i co najmniej 6 miesięcy u biorców przeszczepu nerki³
D+/R+ lub D-/R+ – zalecana profilaktyka przeciwwirusowa przez 3 miesiące u biorców przeszczepu nerki i wątroby³
D-/R- – nie zaleca się rutynowej profilaktyki przeciwwirusowej¹³

Należy rozważyć profilaktykę valgancyklowirem przez co najmniej 3 miesiące po rozpoczęciu leczenia ostrego odrzucania przeszczepu, jeśli dawca lub biorca są CMV-pozytywni (D+/R-, D+/R+ lub D-/R+)¹³.

Biorcy przeszczepów komórek macierzystych

U biorców allogenicznego przeszczepienia komórek macierzystych (HSCT) najczęściej stosuje się strategię wyprzedzającą, ale letermowir jest obecnie zatwierdzony do profilaktyki u seropozytywnych biorców²¹. Letermowir powinien być rozpoczęty w ciągu 28 dni po transplantacji i kontynuowany do 100 dnia po przeszczepieniu⁸.

U pacjentów z wysokim ryzykiem reaktywacji CMV, takich jak biorcy pępowiny lub przeszczepów z deplecją limfocytów T, należy szczególnie rozważyć profilaktykę letermovirem²¹. Należy pamiętać, że letermowir nie ma aktywności przeciwko innym herpeswirusom, dlatego konieczne jest dodatkowe podawanie leków przeciwwirusowych w celu profilaktyki HSV²².

Pacjenci z HIV

Choroba CMV jest najlepiej zapobiegana u pacjentów z HIV poprzez stosowanie terapii antyretrowirusowej (ART) w celu utrzymania liczby komórek CD4+ >100 komórek/mm³⁹. Randomizowane badanie kontrolowane placebo wykazało, że valgancyklowir nie zmniejsza ryzyka rozwoju choroby narządowej CMV u pacjentów z AIDS i wysokim ryzykiem (liczba CD4+ <100 komórek/mm³ i wiremia CMV wykryta w badaniu PCR DNA CMV w osoczu)⁹.

Pacjenci z zaawansowanym HIV powinni być informowani o znaczeniu zwiększonej liczby mętnień w polu widzenia i należy im doradzić regularne ocenianie ostrości wzroku za pomocą prostych technik, takich jak czytanie gazety²³.

Dzieci

U dzieci z HIV w wieku poniżej 6 lat zaleca się badanie przeciwciał anty-CMV w wieku 1 roku, a następnie co roku u dzieci seronegatywnych z immunosupresją (liczba komórek CD4+ <100 komórek/mm³ lub odsetek CD4+ <10%)²⁴.

Nie zaleca się pierwotnej profilaktyki przeciwko chorobie CMV u dzieci z HIV, które nie są poważnie immunosupresyjne²⁴. U dzieci z HIV w wieku ≤5 lat, które są zakażone CMV i poważnie immunosupresyjne (tj. liczba CD4+ ≤50 komórek/mm³ lub odsetek CD4+ ≤5%), należy wykonywać badanie rozszerzonego dna oka przez okulistę co 6 miesięcy²⁵.

Czas trwania profilaktyki CMV

Optymalny czas trwania profilaktyki CMV nie jest jednoznacznie określony i zależy od wielu czynników, w tym typu przeszczepu i indywidualnego ryzyka pacjenta⁴. Najczęściej stosowane schematy to:

3-6 miesięcy po przeszczepieniu narządów miąższowych³
Co najmniej 6 miesięcy u biorców przeszczepu nerki z grupy wysokiego ryzyka (D+/R-)³
Do 100 dni po allogenicznym HSCT w przypadku letermowiru⁸
200 dni po przeszczepieniu nerki w przypadku letermowiru u pacjentów D+/R-²⁶

Dłuższe okresy profilaktyki okazały się bardziej skuteczne niż trzymiesięczna terapia u biorców przeszczepów nerki i płuc²⁷. Niektórzy eksperci zalecają przedłużenie okresu profilaktyki CMV do czasu zmniejszenia immunosupresji²⁸.

Monitorowanie w trakcie profilaktyki

Podczas profilaktyki CMV ważne jest regularne monitorowanie pacjentów pod kątem skuteczności, działań niepożądanych i rozwoju oporności¹³²⁹:

Monitorowanie morfologii krwi co najmniej co 2 tygodnie podczas stosowania valgancyklowiru¹³
W przypadku wystąpienia działań niepożądanych, takich jak neutropenia, należy rozważyć przejście na monitorowanie CMV i terapię wyprzedzającą²⁹
Laboratoria kliniczne powinny używać ilościowych testów kwasów nukleinowych (QNAT) pełnej krwi lub osocza do ilościowego oznaczania wiremii CMV²⁹
Po zakończeniu profilaktyki letermovirem zaleca się monitorowanie reaktywacji CMV⁷

W przypadku strategii wyprzedzającej należy ocenić wiremię CMV po 2 tygodniach leczenia i powtarzać badanie w minimalnych odstępach 7-dniowych²⁹. Czas trwania terapii wyprzedzającej powinien być zindywidualizowany, z cotygodniowym pomiarem CMV QNAT lub antygenu pp65⁴.

Ogólne środki zapobiegawcze

Oprócz farmakologicznej profilaktyki, ważne są ogólne środki zapobiegawcze, szczególnie u kobiet w ciąży i osób z obniżoną odpornością³⁰³¹:

Częste mycie rąk wodą z mydłem przez 15-20 sekund, szczególnie po kontakcie z małymi dziećmi lub ich pieluchami, śliną lub innymi wydzielinami³⁰
Unikanie kontaktu z łzami i śliną podczas całowania dziecka. Zamiast całować dziecko w usta, lepiej całować je w czoło³⁰
Unikanie dzielenia się jedzeniem lub piciem z tej samej szklanki³⁰
Ostrożność przy wyrzucaniu pieluch, chusteczek i innych przedmiotów zanieczyszczonych płynami ustrojowymi³⁰
Czyszczenie zabawek i blatów, które mają kontakt z moczem lub śliną dzieci³²
Stosowanie bezpiecznych praktyk seksualnych, w tym używanie prezerwatyw podczas kontaktów seksualnych³²

Dla pracowników opieki nad dziećmi i pracowników służby zdrowia ważne jest traktowanie wszystkich płynów ustrojowych jako potencjalnie zakaźnych i używanie środków ochrony osobistej, takich jak rękawiczki, gdy istnieje ryzyko kontaktu z płynami ustrojowymi³³.

Szczepienia przeciwko CMV

Obecnie nie ma dostępnej szczepionki przeciwko CMV do zastosowania klinicznego, chociaż prace nad nią trwają od kilku dekad³⁴. Badane są szczepionki eksperymentalne dla kobiet w wieku rozrodczym, które mogą być przydatne w zapobieganiu zakażeniom CMV u matek i niemowląt oraz zmniejszaniu prawdopodobieństwa rozwoju niepełnosprawności u niemowląt urodzonych przez kobiety zakażone podczas ciąży³².

Rozwój szczepionki przeciwko CMV w celu zapobiegania zakażeniom CMV, szczególnie wśród biorców przeszczepów narządów miąższowych z grupy wysokiego ryzyka (D+/R-), jest jednym z priorytetów badawczych³⁴.

Nowe kierunki w profilaktyce CMV

Trwają prace nad nowymi podejściami do profilaktyki CMV, w tym³⁵³⁶:

Monitorowanie odporności komórkowej – ocena specyficznej odpowiedzi immunologicznej przeciwko CMV (CMV-CMI) może pomóc w dostosowaniu wskazań i czasu trwania profilaktyki³⁵
Polimorfizmy genetyczne – identyfikacja biomarkerów genetycznych związanych z ryzykiem choroby CMV³⁵
Komórki T polifunkcyjne specyficzne dla CMV – obecność tych komórek 100 dni po transplantacji wiąże się z niższym ryzykiem późnego wystąpienia choroby CMV³⁶
Połączenie strategii profilaktycznych – badane są podejścia łączące profilaktykę uniwersalną i strategię wyprzedzającą⁶

Lepsze zrozumienie mechanizmów odporności przeciwko CMV może prowadzić do opracowania bardziej spersonalizowanych strategii profilaktycznych, które zoptymalizują ochronę przy jednoczesnym zminimalizowaniu działań niepożądanych³⁵.

Podsumowanie

Profilaktyka zakażeń cytomegalowirusem pozostaje kluczowym elementem opieki nad pacjentami po przeszczepieniu narządów miąższowych, przeszczepieniu komórek macierzystych oraz osobami z obniżoną odpornością¹³. Dostępne są dwie główne strategie: profilaktyka uniwersalna i terapia wyprzedzająca, z których każda ma swoje zalety i wady².

Valgancyklowir pozostaje podstawowym lekiem w profilaktyce uniwersalnej, ale nowe leki, takie jak letermowir, oferują obiecujące alternatywy z lepszym profilem bezpieczeństwa, szczególnie u pacjentów z ryzykiem mielosupresji¹⁶. Czas trwania profilaktyki powinien być dostosowany do indywidualnego ryzyka pacjenta, rodzaju przeszczepu i schematu immunosupresji³.

Oprócz farmakologicznej profilaktyki, istotne są ogólne środki zapobiegawcze, szczególnie u kobiet w ciąży i osób z obniżoną odpornością³⁰. Badania nad szczepionkami przeciwko CMV i nowymi strategiami profilaktycznymi, w tym monitorowaniem odporności komórkowej, mogą w przyszłości poprawić skuteczność zapobiegania zakażeniom CMV³⁵.

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Materiały źródłowe

#1 Prevention and management of CMV infection in pediatric solid organ transplant recipients
https://pmc.ncbi.nlm.nih.gov/articles/PMC9986459/
Human cytomegalovirus (CMV) remains one of the most common opportunistic infections following solid organ transplantation in children. […] In recent years, several new agents have emerged for the prevention and treatment of CMV disease in solid organ transplant recipients. […] This review provides an up-to-date overview of treatment modalities used to prevent and treat CMV disease in solid organ transplant (SOT) recipients. […] Antiviral prophylaxis and pre-emptive therapy are two strategies employed to prevent invasive CMV disease in SOT recipients. […] Prophylaxis therapy involves antiviral administration to all at-risk patients from the time of transplant to at least 36 months post-transplant or longer. […] Preemptive therapy may be used for effective prevention of CMV disease in solid organ transplant recipients.
#2
https://link.springer.com/article/10.1007/s15010-024-02441-4
Cytomegalovirus (CMV) is associated with significant morbidity and mortality among solid organ transplant (SOT) recipients. Strategies for CMV prevention include universal prophylaxis or preemptive approach. We aimed to evaluate the optimal approach. […] Preemptive approach is a reasonable approach for CMV prevention in SOT recipients, if feasible. Strategies for combining the preemptive with prophylaxis strategies, as well as immune monitoring, should be investigated. […] CMV prevention in transplant recipients is achieved through either universal prophylaxis or preemptive therapy. Universal prophylaxis is implemented through administration of antiviral therapy for a predefined period to all SOT recipients. The preemptive strategy is carried out by periodic CMV viremia monitoring using serial PCR-based assays to detect viral replication and provide early treatment to prevent CMV disease.
#3 Prophylaxis of Cytomegalovirus Infection | TRRM
https://www.dovepress.com/prophylaxis-of-cytomegalovirus-infection-in-solid-organ-transplantatio-peer-reviewed-fulltext-article-TRRM
Cytomegalovirus infection is one of the opportunistic infections that occur within the first year of solid organ transplantation (SOT). Antiviral prophylaxis like valganciclovir is recommended for organ transplant recipients if the donors are seropositive. […] The American Society of Transplantation established a risk category for CMV prevention after SOT based on their serology of donors and recipients. Two approaches had been established to prevent CMV after SOT including antiviral prophylaxis and preemptive therapy. […] According to AST, the recommendations for CMV prevention, particularly after kidney and liver transplantation, for CMV D/R SOT recipient antiviral prophylaxis are not recommended. However, antiviral prophylaxis is recommended for CMV D/R+, for 3 months for both kidney and liver SOT recipients. Also, for CMV D+/R antiviral prophylaxis is recommended, and the duration of antiviral prophylaxis is 3 to 6 months for liver SOT recipients. However, the duration of antiviral prophylaxis must be at least 6 months in kidney transplantation recipients.
#4 Prevention and management of CMV infection in pediatric solid organ transplant recipients
https://pmc.ncbi.nlm.nih.gov/articles/PMC9986459/
The duration of preemptive therapy should be individualized with CMV QNAT or pp65 antigenemia measured weekly. […] Antiviral prophylaxis may be given to any at-risk patients to prevent CMV disease after solid organ transplantation. […] Valganciclovir is the preferred agent. […] The optimal duration of CMV prophylaxis is unclear. […] The risk of CMV infection/disease is the highest among lung, intestine, and vascularized composite tissue allograft recipients. […] Furthermore, CMV immunoglobulins may be used for additional protection, particularly in lung transplant recipients; however, data on the efficacy of immunoglobulins for the prevention of CMV disease are limited. […] The preemptive therapy includes close surveillance of CMV viremia and prompt initiation of treatment with valganciclovir or oral ganciclovir when viremia is detected.
#5 Prevention and management of CMV infection in pediatric solid organ transplant recipients
https://pmc.ncbi.nlm.nih.gov/articles/PMC9986459/
Both antiviral prophylaxis and preemptive therapy are associated with risks and benefits. […] While antiviral prophylaxis prevents early CMV viremia and is reported to improve long-term graft survival, it is associated with myelotoxicity, increased cost, and greater incidence of late-onset CMV disease. […] There is evidence that neutralizing antibodies have a role in preventing CMV disease. […] Monoclonal antibodies are more target specific, have greater potency, and less toxicity. […] Identification of Donor+/Recipient CMV transplant recipients who are at highest risk for having CMV disease using a laboratory marker will offer a more selective and appropriate use of prophylaxis, leading to better transplant outcomes. […] The treatment of CMV in pediatric SOT recipients is largely derived from the adult literature.
#6
https://link.springer.com/article/10.1007/s15010-024-02441-4
The major disadvantages of universal prophylaxis are drug toxicity, including leukopenia and neutropenia, and late-onset CMV disease. By contrast, with the preemptive approach, antivirals are less often prescribed and delayed-onset CMV disease has been reported to be less common. […] Our finding of higher rates of acute kidney injury with prophylaxis was not demonstrated previously. […] In summary, using CMV prophylaxis after solid organ transplant resulted in lower rates of CMV infection and higher acute kidney injury rates with no difference in CMV disease at 12 months post-transplantation. Late-onset CMV disease rates were lower with preemptive therapy. No significant difference in overall mortality or graft related outcomes were documented. CMV preemptive approach is reasonable for CMV prevention in SOT recipients, if logistically and economically feasible. Optimal viral load cutoff values for therapy and optimal frequency of monitoring should be further explored. Strategies for combining the two approaches, as well as immune monitoring, should be investigated.
#7 U.S. FDA Approves New Indication for Merckâs PREVYMISÂ® (letermovir) for Prevention of Cytomegalovirus (CMV) Disease in High-Risk Adult Kidney Transplant Recipients – Merck.com
https://www.merck.com/news/u-s-fda-approves-new-indication-for-mercks-prevymis-letermovir-for-prevention-of-cytomegalovirus-cmv-disease-in-high-risk-adult-kidney-transplant-recipients/
PREVYMIS now approved for CMV prophylaxis after kidney transplant in Donor CMV-seropositive/Recipient CMV-seronegative patients. […] The FDA approval of PREVYMIS for CMV disease prophylaxis in adult kidney transplant recipients was supported by a Phase 3, randomized, multicenter, double-blind, active comparator-controlled non-inferiority trial (P002, NCT03443869) in 589 adult kidney transplant recipients at high risk (CMV D+/R-). […] The recommended dosage of PREVYMIS is 480 mg administered once daily orally or as an intravenous infusion, initiated as early as Day 0 and up to Day 7 post-kidney transplant and continued through Day 200 post-transplant. […] Following the completion of PREVYMIS prophylaxis, monitoring for CMV reactivation is recommended. […] PREVYMIS inhibits viral replication by targeting the CMV DNA terminase complex. […] PREVYMIS is now approved for prophylaxis of CMV disease in adult kidney transplant recipients at high risk (Donor CMV-seropositive/Recipient CMV-seronegative [D+/R-]).
#8 :: IC :: Infection & Chemotherapy
https://www.icjournal.org/DOIx.php?id=10.3947/ic.2024.0140
Cytomegalovirus (CMV) is a significant concern for patients with allogeneic hematopoietic cell transplantation (allo-HCT). […] Following allo-HCT, CMV prophylaxis with letermovir is crucial to prevent reactivation in seropositive recipients. […] Letermovir was introduced in Korea in 2020; it is effective in preventing CMV reactivation in patients with allo-HCT having tolerable safety profiles. […] Letermovir should be started within 28 days post-transplantation if the serum CMV DNA titer is below the lower limit of detection and continued until day 100. […] Our protocol includes testing CMV DNA PCR as early as possible and starting letermovir on days 12 for seropositive recipients. […] Preemptive therapy was initiated when the serum CMV titer reached 500 IU/mL for high-risk patients and 1,000 IU/mL for low-risk patients.
#9 Cytomegalovirus Disease: Adult and Adolescent OIs | NIH
https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/cytomegalovirus
Cytomegalovirus (CMV) is a double-stranded DNA virus in the herpesvirus family that can cause disseminated or localized end-organ disease in people with HIV with advanced immunosuppression. […] CMV end-organ disease is best prevented using ART to maintain the CD4 count 100 cells/mm3. […] A randomized, placebo-controlled trial addressed whether valganciclovir (the current standard oral agent for treatment of CMV disease) in addition to ART might reduce CMV end-organ disease in AIDS patients at high risk (CD4 count 100 cells/mm3 and CMV viremia detected by plasma CMV DNA PCR assay). This study failed to show a benefit for such preventive therapy; therefore, valganciclovir primary prophylaxis is not recommended to prevent CMV end-organ disease in people with HIV, even among patients who have CMV viremia.
#10 Cytomegalovirus infection in kidney transplant patients: what is the best way to prevent it? | NefrologÃa
https://revistanefrologia.com/en-cytomegalovirus-infection-in-kidney-transplant-articulo-X2013251408005834
Cytomegalovirus infection in kidney transplant patients: what is the best way to prevent it? […] The article published in this issue by Guirado et al.1 analysed the results of a prospective study conducted in the 2004-2006 period in a group of patients receiving kidney transplants in whom the intervention to prevent infection by cytomegalovirus (CMV) (prophylaxis or pre-emptive therapy) was selected based on the infection risk of the patient. […] Authors identified as patients with a high risk for developing CMV disease negative recipients from positive donors (D+/R-), patients receiving antilymphocytic sera, and patients who need increased immunosuppression due to rejection episodes. This group received prophylaxis with valganciclovir for 100 days. […] In addition to direct effects, CMV infection also has indirect effects.
#10 Cytomegalovirus infection in kidney transplant patients: what is the best way to prevent it? | NefrologÃa
https://revistanefrologia.com/en-cytomegalovirus-infection-in-kidney-transplant-articulo-X2013251408005834
In a D+/R- setting, prophylaxis is recommended with oral valganciclovir 900 mg/day or oral valacyclovir 2 g/6 h, or intravenous ganciclovir 6 mg/kg/day in the event of oral intolerance, for up to 3 months after transplant. […] In patients treated with antilymphocyte sera, use of intravenous ganciclovir 5 mg/kg/day, with kidney function adjustment, for at least 2 weeks was recommended during treatment with antithymocyte sera, plasmapheresis, or anti-CD20 antibodies. […] In patients with a low to moderate risk (R+), there are data supporting use of pre-emptive therapy with intravenous ganciclovir (5 mg/kg/12 h) adjusted to kidney function for 2 weeks under monitoring. […] The decision about treatment used to prevent CMV infection may be adapted to patient risk, selecting the preventive measure that is most effective and safe for the patient and also decreases the risks of unnecessary toxicity and long-term exposure.
#11 List of 9 CMV Prophylaxis Medications Compared
https://www.drugs.com/condition/cmv-prophylaxis.html
Cytomegalovirus (CMV) prophylaxis is medication used to prevent the reactivation of CMV infection. […] The aim of CMV prophylaxis is to keep the CMV suppressed so that it does not cause an active infection. […] The medications listed below are related to or used in the treatment of this condition. […] Valcyte is used to treat CMV Prophylaxis. […] Valacyclovir is used to treat CMV Prophylaxis. […] Valganciclovir is used to treat CMV Prophylaxis. […] Ganciclovir is used to treat CMV Prophylaxis. […] Letermovir is used to treat CMV Prophylaxis. […] Prevymis is used to treat CMV Prophylaxis. […] CytoGam is used to treat CMV Prophylaxis. […] Cytomegalovirus immune globulin is used to treat CMV Prophylaxis.
#12 Prevention and management of CMV infection in pediatric solid organ transplant recipients
https://pmc.ncbi.nlm.nih.gov/articles/PMC9986459/
Cautious reduction in immune suppression and treatment with antiviral agents remain the mainstay for treatment of CMV infection in children. […] Ganciclovir and its oral pro-drug valganciclovir, compete with deoxyguanosine triphosphate for binding to viral DNA polymerase, thereby inhibiting viral DNA synthesis. […] Ganciclovir and valganciclovir resistance can occur in up to 2%-4% of pediatric patients with CMV infection. […] Treatment of ganciclovir-resistant CMV disease continues to remain a challenge. […] Maribavir is a CMV enzyme pUL97 kinase inhibitor that was FDA-approved in November 2021 for the treatment of post-transplant refractory CMV infection in both adult and pediatric patients. […] Letermovir is novel CMV DNA terminase enzyme complex inhibitor FDA approved for the prevention of CMV infection and disease in adult CMV-seropositive recipients of allogeneic HSCT.
#13 UK GUIDELINE ON PREVENTION AND MANAGEMENT OF CYTOMEGALOVIRUS (CMV) INFECTION AND DISEASE FOLLOWING SOLID ORGAN TRANSPLANTATION – British Transplantation Society
https://bts.org.uk/uk-guideline-on-prevention-and-management-of-cytomegalovirus-cmv-infection-and-disease-following-solid-organ-transplantation/
1.1 All organ donors and recipients should be screened for CMV (IgG antibody) serostatus prior to, or at the time of transplantation [1A] […] 1.3 Offer Valganciclovir prophylaxis to people receiving kidney and liver transplants for at least 3 months following transplantation if either: […] 1.4 Consider Valganciclovir prophylaxis for people receiving heart, lung, intestinal or pancreas transplants for at least 3 months following transplantation if either: […] 1.5 Do not routinely offer Valganciclovir prophylaxis if donor and recipient are seronegative for CMV (D-/R-) [1D] […] 1.6 Consider Valganciclovir prophylaxis for at least 3 months after starting treatment for acute allograft rejection if either donor or recipient are CMV positive (D+/R-, D+/R+ or D-/R+) [2C]. […] 1.9 Monitor Full Blood Count at least every 2 weeks whilst on Valganciclovir [1A]
#14 Valacyclovir versus valganciclovir for cytomegalovirus prophylaxis in kidney transplant recipients: a systematic review and comparative meta-analysis
https://www.ctrjournal.org/journal/view.html?uid=2291&vmd=Full
Regarding prophylaxis, although ValG is most widely used, it has dose-limiting side effects and carries a black box warning for teratogenicity. […] Alternatively, ValA represents an attractive option for some centers due to economic considerations and/or its lower impact on bone marrow suppression. […] The current literature indicates similar rates of CMV DNAemia between these two drugs. […] Our results revealed no statistically significant differences between the two drugs in terms of CMV disease incidence, CMV viremia, acute rejection rates, and the incidences of BK viremia and other HV infections. However, the ValA group exhibited a significantly lower incidence of leukopenia/neutropenia. […] The comparison between ValA and ValG showed comparable efficacy in preventing CMV disease. […] ValG was associated with a significantly higher risk of leukopenia and exhibited more pronounced immunosuppressive effects compared to ValA.
#15 Cytomegalovirus (CMV) Medication: Antivirals, Immune Globulin, Antimetabolite
https://emedicine.medscape.com/article/215702-medication
Letermovir, a member of the novel class of 3,4-dihydroquinazolinyl acetic acids, is indicated for CMV prophylaxis in adult CMV-seropositive recipients of an allogeneic HSCT and kidney transplant recipients. […] It is indicated for prophylaxis of CMV infection and disease in adult CMV-seropositive recipients [R+] of an allogeneic hematopoietic stem cell transplant (HSCT). Additionally, it is indicated for prophylaxis of CMV disease in adult kidney transplant recipients at high risk (donor CMV seropositive/recipient CMV seronegative [D+/R-]). […] CMV immune globulin (CMV-IG) is a preparation of immunoglobulin derived from pooled healthy blood donors with high CMV titers; administration provides a passive source of antibodies against cytomegalovirus. It may also be used for CMV prophylaxis in heart, lung, kidney, liver and pancreas transplant recipients, in addition to ganciclovir.
#16 Letermovir Non-inferior to Valganciclovir for CMV Prophylaxis, With Lower Leukopenia Rates – International Society of Nephrology
https://www.theisn.org/blog/2023/10/30/letermovir-non-inferior-to-valganciclovir-for-cmv-prophylaxis-with-lower-leukopenia-rates/
Letermovir was non-inferior to valganciclovir for prevention of CMV disease through 52 weeks (10.4% vs 11.8%, difference 1.4%; 95%CI 6.5% to 3.8%). […] Letermovir is an alternative antiviral therapy approved by the US Food and Drug Administration and the European Medicines Agency for prophylaxis of CMV infection and disease in adult CMV-seropositive recipients of an allogeneic hematopoietic stem cell transplant. […] This trial showed that letermovir was non-inferior to valganciclovir for prophylaxis of CMV disease in adult CMV-seronegative renal transplant recipients who received an organ from a CMV-seropositive donor, with lower rates of leukopenia or neutropenia, supporting its use for this indication.
#17 Frontiers Publishing Partnerships | New Treatment Options for Refractory/Resistant CMV Infection
https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2023.11785/full
In the phase 3 trial, 601 CMV D+/Râ adult kidney transplant recipients were randomized to receive prophylaxis with either valganciclovir or letermovir 480 mg once daily (240 mg if used with cyclosporine) until week 28 after transplantation. Primary efficacy endpoint of the study was met, as letermovir was non-inferior to valganciclovir in preventing CMV disease (frequency 10.4% in the letermovir vs. 11.8% in the valganciclovir group). Importantly, letermovir resulted in lower toxicity compared to valganciclovir, especially lower rate of leukopenia (11.3% vs. 37%) or neutropenia (2.7% vs. 16.5%), and lower rate of drug discontinuation due to adverse events (4.1% vs. 13.5%). The study results are very convincing for the good efficacy of letermovir also in the SOT setting, when used as prophylaxis, and have recently led to the expanded indication mentioned above, by the US FDA.
#18 Letermovir for Cytomegalovirus Prophylaxis in Lung Transplant Patients with Valganciclovir-Induced Leukopenia
https://www.mdpi.com/2673-3943/2/2/13
Letermovir, a novel antiviral agent approved for CMV prophylaxis in hematopoietic cell transplantation, preferentially targets and inhibits the CMV viral terminase, a virus-specific enzyme complex encoded by genes UL51, UL56, and UL89 and responsible for cleavage and translocation of CMV progeny DNA into capsids. […] In an effort to minimize the risk of leukopenia in our patients due to valganciclovir, we utilized letermovir, a novel CMV antiviral, for prophylaxis in patients with valganciclovir-induced leukopenia. […] Letermovir was therefore discontinued in nine patients at 1 year post-transplant or when insurance approval of medication coverage ended, whichever came first. […] Our data suggest that letermovir is a generally safe and effective alternative to valganciclovir for CMV prophylaxis in lung transplant recipients unable to tolerate the standard of care valganciclovir due to leukopenia. Letermovir is well-tolerated with a favorable side effect profile when used in conjunction with other myelosuppressive agents.
#19 High-dose aciclovir in CMV infection prophylaxis after allogeneic HSCT: a single-center long-term experience | Bone Marrow Transplantation
https://www.nature.com/articles/s41409-023-02081-6
At the same time, CMV-specific immunity reconstitution probably wasn’t negatively affected, which is important to prevent late CMV reactivations. […] Regarding our results, HD-aciclovir seems to be an option for the prophylaxis of CMV reactivation in intermediate risk patients (CMV R+/D+, T-lymphodepletion etc.), for example in cases of letermovir unavailability or financial obstacles, or in low-risk CMV seronegative recipients. […] To prevent CMV disease, a combination of HD-aciclovir prophylaxis and a standard preemptive approach (CMV viremia monitoring and early preemptive treatment) is required.
#20 Cytomegalovirus immune globulin (CMV-IG, Cytogam) | Department of Internal Medicine | University of Nebraska Medical Center
https://www.unmc.edu/intmed/divisions/id/asp/protected-antimicrobials/cytomegalovirus.html
CMV-IG is FDA-approved for the prophylaxis of cytomegalovirus (CMV) disease associated with kidney, lung, liver, pancreas or heart transplantations.1 The additional benefit of CMV-IG when added to effective antiviral agents (e.g ganciclovir, valganciclovir) for CMV prophylaxis in solid organ transplantation is questionable and supporting evidence is limited.2,3 Some centers utilize CMV-IG for prophylaxis but recent international consensus guidelines leave the issue unanswered. They suggest CMV-IG may be considered in addition to antiviral agents for CMV prophylaxis only in heart, lung, and intestinal transplants (Grade III recommendation, expert opinion descriptive studies).3 Furthermore, current guidelines do not recommend routine use of CMV-IG for the treatment of CMV disease as there are a paucity of data supporting this practice. The data that do exist consists of nonrandomized or retrospective studies primarily evaluating CMV pneumonitis. 3-9 (Please see attached literature review.)
#21 Letermovir for the prevention of cytomegalovirus infection and disease | IDR
https://www.dovepress.com/letermovir-for-the-prevention-of-cytomegalovirus-infection-and-disease-peer-reviewed-fulltext-article-IDR
For example, antiviral prophylaxis is a preferred approach among highest-risk SOT recipients, such as CMV D+/R, lung, intestinal and composite tissue transplant patients. […] Among allogeneic HSCT recipients, the preferred approach is CMV surveillance followed by preemptive therapy of asymptomatic CMV replication. […] Letermovir is the newest FDA-approved drug for CMV prophylaxis in allogeneic HSCT recipients. […] The approval of letermovir for CMV prophylaxis was based on results of a phase III randomized, placebo-controlled trial that enrolled 565 CMV-seropositive allogeneic HSCT recipients. […] The approval of letermovir paves the way for antiviral prophylaxis as another safe and effective option for the prevention of CMV infection and disease in allogeneic HSCT recipients. […] However, letermovir prophylaxis should be strongly considered for those considered high-risk for CMV reactivation, such as recipients of umbilical cords and T-cell-depleted grafts.
#22 Letermovir for the prevention of cytomegalovirus infection and disease | IDR
https://www.dovepress.com/letermovir-for-the-prevention-of-cytomegalovirus-infection-and-disease-peer-reviewed-fulltext-article-IDR
If letermovir prophylaxis is chosen as the method for prevention, we emphasize the need to provide antiviral drugs for HSV prophylaxis (as letermovir has no activity against HSV, varicella zoster and other herpesviruses). […] Letermovir is not approved for any clinical indications in SOT recipients. […] However, it is being investigated for its role as CMV prophylaxis in high-risk CMV D+/R SOT recipients. […] In the absence of randomized controlled trial results to demonstrate its efficacy and safety, letermovir is not yet recommended for antiviral prophylaxis in SOT recipients. […] Letermovir is a novel viral terminase inhibitor that is currently approved for CMV prophylaxis in CMV-seropositive allogeneic HSCT recipients.
#23 Cytomegalovirus Disease: Adult and Adolescent OIs | NIH
https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/cytomegalovirus
The primary method for preventing severe CMV disease is recognizing the early manifestations of the disease and instituting proper therapy. […] Patients who have a low CD4 cell count (100cells/mm3) and are not on ART should be made aware of the implications of increased floaters in the eye and be advised to assess their visual acuity regularly using simple techniques, such as reading newsprint. […] Development of floaters or changes in visual acuity should prompt an urgent referral to ophthalmology. […] In the premodern ART era, some specialists recommended ophthalmologic examinations every 3 to 4 months for patients with CD4+ cells 50 cells/mm3, because up to one-half of early CMV retinitis was asymptomatic. However, with the decline in CMV incidence in the modern ART era, the value of this recommendation is unknown. […] Some clinicians do recommend a baseline ophthalmologic exam for people with HIV with CD4 100 cells/mm3.
#24 Cytomegalovirus: Pediatric OIs | NIH
https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-pediatric-opportunistic-infections/cytomegalovirus
CMV antibody testing is recommended at age 1 year (or at baseline evaluation if age 1 year at initial visit) and then annually for CMV-seronegative infants and children with HIV who are immunosuppressed (i.e., CD4 T lymphocyte [CD4] cell count 100 cells/mm3 or CD4 percentage 10%) (strong, low). […] Testing for congenital CMV infection in the first 21 days of life is recommended for infants with vertically transmitted HIV (strong, low). CMV testing is also suggested for all infants exposed to HIV since their HIV status will be indeterminate during the first 21 days of life when congenital CMV infection can be diagnosed (weak, low). Infants with confirmed congenital CMV infection should be evaluated regularly for early detection of hearing loss and appropriate intervention. […] Primary prophylaxis against CMV disease is not recommended for children with HIV who are not severely immunocompromised (strong, moderate). CMV end-organ disease is best prevented by antiretroviral therapy (ART) to maintain the CD4 count 100 cells/mm3 in children aged 6 years, or CD4 percentage 10% in children aged 6 years (strong, moderate).
#25 Cytomegalovirus: Pediatric OIs | NIH
https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-pediatric-opportunistic-infections/cytomegalovirus
Children with HIV aged 5 years who are CMV infected and severely immunosuppressed (i.e., CD4 count 50 cells/mm3 or CD4 percentage 5%) should have a dilated retinal examination performed by an ophthalmologist every 6 months (strong, low). […] Treatment with antiviral therapy against CMV in addition to ART is recommended for CMV disease in children with HIV (strong, moderate). Intravenous (IV) ganciclovir is the drug of choice for initial treatment for acquired CMV disease, including retinitis and other end-organ disseminated CMV disease (e.g., colitis, esophagitis, and CNS disease). Transition from IV ganciclovir to oral valganciclovir can be considered for patients who improve on IV therapy (strong, moderate). […] After induction therapy, secondary prophylaxis (chronic maintenance therapy) is recommended for most forms of CMV disease until immune reconstitution or, in the absence of immune reconstitution, for the remainder of a patients life. Regimens for chronic suppression include IV ganciclovir, oral valganciclovir, IV foscarnet, combined IV ganciclovir and foscarnet, and IV cidofovir (strong, moderate).
#26 UCSF Cytomegalovirus Trial â Kidney Transplant Preemptive Therapy or Prophylaxis for CMV Prevention in D+R Recipients
https://clinicaltrials.ucsf.edu/trial/NCT06798909
This is a prospective, randomized multicenter trial of preemptive therapy (PET) vs. antiviral prophylaxis (AP) for prevention of cytomegalovirus (CMV) disease in adult D+R- kidney transplant recipients (KTR). […] Patients meeting study eligibility criteria and who have provided informed consent will be randomized (1:1) within 7 days of transplant to receive, in an open label design, either AP with valganciclovir 900 mg orally once daily or letermovir 480 mg orally once daily for 200 days post-transplant, or PET (central lab weekly plasma polymerase chain reaction (PCR) monitoring for CMV deoxyribonucleic acidemia (DNAemia)) for 100 days post-transplant, with oral valganciclovir 900mg orally twice daily at onset of CMV DNAemia at any level and continued until plasma CMV DNAemia is negative or below the level of quantitation in two consecutive weekly plasma samples.
#27 Antiviral medications for preventing cytomegalovirus disease in solid organ transplant recipients – Vernooij, RWM – 2024 | Cochrane Library
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003774.pub5/abstract
In people who have received a solid organ transplant, giving antiviral medications reduces cytomegalovirus (CMV) disease and death from CMV disease, compared with placebo or no treatment. […] Longer periods of prophylaxis were found to be more effective than three months of therapy in kidney and lung transplant recipients. […] Low-dose valganciclovir was found to be as effective as the standard dose for preventing CMV in moderate-risk kidney transplant recipients. […] CMV (a herpes virus) is the most common type of virus in people who have received solid organ transplants (kidney, heart, liver, lung and pancreas). CMV is a major cause of illness and death during the first year after transplantation. […] We wanted to look at both the benefits and harms of antiviral medication to prevent CMV disease in people who have received a solid organ transplant.
#28 Cytomegalovirus (CMV) Treatment & Management: Medical Care, Consultations, Activity
https://emedicine.medscape.com/article/215702-treatment
Prophylaxis is provided to all patients who have positive CMV serology results. Positive findings on blood cultures, pp65 antigenemia, and CMV PCR have been used as markers for the initiation of therapy. […] Recent data favor universal prophylaxis with either ganciclovir or valganciclovir in high-risk liver transplant recipients. […] Prophylactic approaches have been very successful in eliminating CMV disease; however, toxicities are increased with this approach because patients without viral reactivation may be exposed to antiviral therapy. […] Some experts recommend extending the duration of CMV prophylaxis to the period of reduced immunosuppression. […] Letermovir, a novel viral terminase inhibitor, has been used for primary prevention of CMV in sero-positive allo-HSCT recipients, however, has not been approved for solid organ transplant recipients.
#29 UK GUIDELINE ON PREVENTION AND MANAGEMENT OF CYTOMEGALOVIRUS (CMV) INFECTION AND DISEASE FOLLOWING SOLID ORGAN TRANSPLANTATION – British Transplantation Society
https://bts.org.uk/uk-guideline-on-prevention-and-management-of-cytomegalovirus-cmv-infection-and-disease-following-solid-organ-transplantation/
1.10 Consider switching to CMV monitoring and pre-emptive therapy if people develop side effects e.g.; neutropenia, on Valganciclovir [1C] […] 2.1 Clinical Laboratories should use Quantitative Nucleic Acid Testing (QNAT) of whole blood or plasma to quantify CMV viral load [1A] […] 3.1 Offer monitoring of CMV viral load to guide pre-emptive therapy to adults, children and young people receiving a solid organ transplant if: […] 4.1 Offer treatment with oral Valganciclovir for a duration of at least 2 weeks [1A] […] 4.4 Assess CMV viral load after 2 weeks of treatment and repeat at a minimum interval of 7 days [1D] […] 6.1 Consider a dose reduction of either calcineurin inhibitor or mycophenolate mofetil / azathioprine [1C] […] 7.1 Offer balanced and accurate information to children, adults and young people undergoing solid organ transplantation about: […] 7.4 Ensure that healthcare professionals offering information have specialist knowledge about CMV infection and disease and their treatment, and the skills to support shared decision-making.
#30 Cytomegalovirus (CMV) infection – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/cmv/symptoms-causes/syc-20355358
Careful hygiene is the best prevention against CMV. You can take these precautions: […] Wash your hands often. Use soap and water for 15 to 20 seconds, especially if you have contact with young children or their diapers, saliva or other oral secretions. This is especially important if the children attend child care. […] Avoid contact with tears and saliva when you kiss a child. Instead of kissing a child on the lips, for instance, kiss on the forehead. This is especially important if you’re pregnant. […] Avoid sharing food or drinking out of the same glass as others. Sharing glasses and kitchen utensils can spread CMV. […] Be careful with disposable items. When disposing of diapers, tissues and other items that have been contaminated with bodily fluids, wash your hands thoroughly before touching your face.
#31 Cytomegalovirus – Control and Prevention | Occupational Safety and Health Administration
http://www.osha.gov/cytomegalovirus/control-prevention
Cytomegalovirus (CMV) poses significant risks to developing fetuses. Women who are pregnant or who may become pregnant should be informed of these risks. […] To prevent or reduce workers’ cytomegalovirus (CMV) infection risk, employers should develop an infection control plan that addresses sources of CMV exposure and infection prevention measures. […] A comprehensive infection control plan will include training on CMV risks. A recommended best practice is for employers to explain CMV risks to employees prior to them becoming pregnant. […] Consider encouraging workers who are pregnant or planning to become pregnant, or those whose sexual partner(s) is or is planning to become pregnant, to discuss potential CMV risks with their healthcare provider. […] Provide disposable gloves and encourage employees to use them for any activities that involve contact with body fluids.
#32 Cytomegalovirus (CMV) infection – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/cmv/symptoms-causes/syc-20355358
Clean toys and countertops. Clean any surfaces that come in contact with children’s urine or saliva. […] Practice safe sex. Wear a condom during sexual contact to prevent spreading CMV through semen and vaginal fluids. […] If you have weakened immunity, you may benefit from taking antiviral medication to prevent CMV disease. […] Experimental vaccines are being tested for women of childbearing age. These vaccines may be useful in preventing CMV infection in mothers and infants, and reducing the chance that babies born to women who are infected while pregnant will develop disabilities.
#33 Cytomegalovirus – Control and Prevention | Occupational Safety and Health Administration
http://www.osha.gov/cytomegalovirus/control-prevention
Workplace surfaces that may be contaminated with body fluids should be cleaned regularly with disinfectant. […] To minimize infection risk, childcare workers should treat all body fluids as if they are infectious, and avoid sharing food, drinks, or utensils with young children. […] Childcare workers concerned about CMV exposure should talk to their healthcare provider about the virus, their infection risk, and ways to keep themselves healthy. […] Healthcare workers should use PPE, such as gloves, whenever there is a chance they may encounter body fluids. […] Healthcare workers who are pregnant or may become pregnant, or those whose sexual partner(s) is or is planning to become pregnant, should speak with their healthcare provider about their risks of contracting CMV in the healthcare environment and how they can protect themselves.
#34 Prevention and management of CMV infection in pediatric solid organ transplant recipients
https://pmc.ncbi.nlm.nih.gov/articles/PMC9986459/
Development of CMV vaccine to prevent CMV infection, especially among high-risk SOT recipients (D+/R) has been underway for several decades; however, there is no currently available vaccine for clinical use. […] Additional research is needed to determine appropriate dosing, the optimal duration of prophylactic therapy, and the risk-benefit analysis of the newer therapies for the pediatric SOT population.
#35
https://journals.lww.com/co-transplantation/fulltext/2024/04000/recent_advances_in_cytomegalovirus_infection.5.aspx
Antiviral agents existing for prophylaxis are ganciclovir/valganciclovir and letermovir, recently approved for prevention of CMV in high-risk kidney SOT with very high safety profile. However, late onset of CMV disease after discontinuation of prophylaxis requires new strategies to prevent this complication. […] New stratification strategies through CMV-CMI, genetic polymorphisms and immune-monitoring may potentially improve tailored indication and duration of prophylaxis for CMV in SOT. […] Despite advances in preventive strategies, CMV infection remains a significant challenge in SOT, being a driver of negative patient and allograft outcomes, especially in the setting of refractory or resistant CMV infections. […] The optimal approach to the prevention and treatment of infection due to CMV remains uncertain, but cell-mediated immunity against CMV has the potential to improve tailored strategies. Letermovir may be as efficient as valganciclovir for preventing CMV disease with fewer myelotoxicity.
#36
https://insight.jci.org/articles/view/180115
We demonstrated that PET significantly reduced the incidence of endpoint committee-adjudicated CMV disease by 1 year after transplant compared with PRO, from 19% to 9%. […] Our results suggest that PET is superior to PRO for CMV disease prevention by allowing low-level CMV replication and associated antigen exposure that is promptly controlled by antiviral therapy and facilitates enhanced CMV protective immunity in D+R LTxR. […] The presence of more than 0 cells/L CMV-specific polyfunctional CD8+ T cells or more than 0.06 cells/L CMV-specific polyfunctional CD4+ T cells at 100 days after transplant was associated with a lower risk of late-onset CMV disease. […] Collectively, these findings suggest that PET, through controlled viral antigen exposure, better facilitates development of CMV-specific immune responses (compared with PRO) and that these immune responses mediate CMV protective immunity against CMV disease among high-risk D+R SOT recipients.