Materiały źródłowe

• #1 Cytomegalovirus (CMV) infection – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cmv/diagnosis-treatment/drc-20355364

  Treatment generally isn’t necessary for healthy children and adults. Healthy adults who develop CMV mononucleosis generally recover without medication. […] Newborns and people who have weakened immunity need treatment when they’re experiencing symptoms of CMV infection. The type of treatment depends on the signs and symptoms and their severity. […] Antiviral medications are the most common type of treatment. They can slow reproduction of the virus, but can’t eliminate it. Researchers are studying new medications and vaccines to treat and prevent CMV.

• #2 Cytomegalovirus (CMV): Symptoms, Causes, Treatment

  https://www.webmd.com/hiv-aids/aids-hiv-opportunistic-infections-cytomegalovirus

  If you’re healthy, usually you won’t need treatment for CMV. Most people get better without any medicine. If you have a weakened immune system or your newborn has CMV, a doctor may suggest treatment depending on how severe the symptoms are. Antiviral medicines are the most common way to treat it. They can’t make the virus go away, but they can slow it down. […] Your doctor might prescribe drugs including: Acyclovir (Sitavig, Zovirax), Cidofovir (Vistide), CMV immune globulin (CytoGam), Foscarnet (Foscavir), Ganciclovir (Cytovene), Leflunomide (Arava), Letermovir (Prevymis), Maribavir (Livtencity), Valganciclovir (Valcyte). […] These drugs generally can’t cure the disease, but they can help if you have a weak immune system and symptoms from a CMV infection. If you have advanced HIV, they can control the infection while you get antiretroviral therapy (ART) for your HIV infection.

• #3 Cytomegalovirus (CMV) Infection – Infections – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/infections/herpesvirus-infections/cytomegalovirus-cmv-infection

  Mild cytomegalovirus infection is usually not treated. It subsides on its own. […] When the infection threatens life or eyesight, an antiviral medication (valganciclovir, ganciclovir, cidofovir, foscarnet, maribavir, or a combination) may be given. These antivirals may be given by mouth or by vein. When CMV retinitis is very severe, the medications may also be injected directly into the eye. These medications have serious side effects and do not cure the infection. However, treatment slows the disease’s progression and may preserve sight. […] Antivirals are used to treat other severe symptoms due to CMV but are less reliably effective than when used to treat retinitis. […] If CMV infection occurs in people whose immune system is temporarily weakened or suppressed (by a disorder or medication), the infection usually subsides when the immune system recovers or the medication is stopped. […] Treating people who have HIV/AIDS with medications used to control HIV (antiretroviral medications) helps protect against CMV infection. […] People who have had an organ transplant are often given antivirals (such as ganciclovir, valganciclovir, or foscarnet) to prevent CMV infection.

• #4 Cytomegalovirus (CMV) – symptoms and treatment | healthdirect

  https://www.healthdirect.gov.au/cytomegalovirus-cmv

  Cytomegalovirus (CMV) is a very common infection. Most people recover from CMV without any special treatment, just like when you have a cold. […] If you have a weakened immune system, your doctor may prescribe antiviral medicines. […] If you are pregnant and have CMV, see your doctor for advice. […] Newborns can be given antiviral medicines. The earlier the treatment is started the better the outcome. […] If you’re at risk from CMV due to a weakened immune system, your doctor may prescribe antiviral medicines. There is no vaccine available to prevent CMV infection.

• #5 Cytomegalovirus (CMV) infection: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000568.htm

  Cytomegalovirus (CMV) infection is a disease caused by a type of herpes virus. […] Most people recover in 4 to 6 weeks without medicine for CMV. Rest is needed, sometimes for a month or longer to regain full activity levels. Painkillers and warm salt-water gargles can help relieve symptoms. […] Antiviral medicines and antibody therapy are usually not used in people with healthy immune function, but may be used for people with an impaired immune system. […] The outcome is good with treatment. The symptoms may be relieved in a few weeks to months.

• #6 Acute cytomegalovirus (CMV) infection Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/acute-cytomegalovirus-cmv-infection

  Most people recover in 4 to 6 weeks without medicine for CMV. Rest is needed, sometimes for a month or longer to regain full activity levels. Painkillers and warm salt-water gargles can help relieve symptoms. […] Antiviral medicines and antibody therapy are usually not used in people with healthy immune function, but may be used for people with an impaired immune system.

• #7 Cytomegalovirus disease in immunocompetent adults | The Medical Journal of Australia

  https://www.mja.com.au/journal/2014/201/10/cytomegalovirus-disease-immunocompetent-adults

  Although limited, current evidence suggests that targeted antiviral therapy with ganciclovir or valganciclovir is appropriate for severe CMV disease in immunocompetent adults. […] While ganciclovir or valganciclovir are currently recommended as first-line treatment for severe CMV disease in immunocompromised adults, few studies have appropriately evaluated the use of these antiviral agents for the treatment of severe CMV disease in immunocompetent adults. […] However, untreated CMV disease is associated with considerable morbidity and mortality, and published case studies and reviews provide consistent case-based evidence of rapid clinical improvement after commencement of therapy in this clinical setting. […] Therefore, the continued use of antivirals for the treatment of very likely or proven CMV disease in immunocompetent adults appears justified at present.

• #8 Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review | Virology Journal | Full Text

  https://virologyj.biomedcentral.com/articles/10.1186/1743-422X-5-47

  We reviewed the evidence associated with severe manifestations of CMV infection in apparently immunocompetent patients and the potential role of antiviral treatment for these infections. […] The clinical practice reported in the literature has been to prescribe antiviral treatment for the most severe manifestations of monophasic meningoencephalitis (seizures and coma), ocular involvement, and lung involvement due to CMV. […] An issue that has not been comprehensively resolved is the potential role of specific antiviral treatment for immunocompetent patients with pronounced clinical manifestations related to CMV infection. […] In this context, we sought to review the biomedical literature for reports regarding severe CMV infections in immunocompetent patients, and to evaluate, on the basis of existing evidence, the role of antiviral treatment, if any, for these patients.

• #9 Cytomegalovirus (CMV) Treatment & Management: Medical Care, Consultations, Activity

  https://emedicine.medscape.com/article/215702-treatment

  There are various CMV-treatment approaches based on the patients CMV status and co-morbidities. Some patients receive prophylaxis whereas some receive preemptive therapy. Prophylaxis is given to a patient to prevent primary, reactivation, or recurrent infection. Preemptive therapy is given to asymptomatic CMV-infected patients with CMV detected by screening tests. Some studies have shown that high-dose acyclovir or valacyclovir prophylaxis markedly reduces CMV infection in allo-HSCT recipients. Intravenous ganciclovir also has been tested, with some reduction in CMV infection; however, this did not provide overall survival benefit and was associated with bone marrow suppression (ganciclovir-induced neutropenia). […] 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.

• #10 New Cytomegalovirus disease treatments 2025 | Everyone.org

  https://everyone.org/explore/treatment/?id=103

  Cytomegalovirus (CMV) disease is an infection caused by the cytomegalovirus, a common virus that typically remains dormant in healthy individuals but can cause serious illness in those with weakened immune systems or pregnant women. […] Treatment options for CMV disease primarily involve antiviral medications designed to control viral replication and minimize symptoms. Common antiviral drugs include ganciclovir, valganciclovir, foscarnet, and cidofovir, which may be administered orally or intravenously depending on the severity of the infection and patient-specific factors. […] Currently, the standard antiviral agents for treating CMV disease include intravenous ganciclovir and its oral prodrug valganciclovir. […] Maribavir (Livtencity) represents a novel antiviral agent recently approved by the FDA for treating CMV infections resistant or refractory to standard antiviral therapies.

• #11 Cytomegalovirus (CMV): Symptoms, Causes, Treatment

  https://www.webmd.com/hiv-aids/aids-hiv-opportunistic-infections-cytomegalovirus

  If you’re healthy, usually you won’t need treatment for CMV. Most people get better without any medicine. If you have a weakened immune system or your newborn has CMV, a doctor may suggest treatment depending on how severe the symptoms are. Antiviral medicines are the most common way to treat it. They can’t make the virus go away, but they can slow it down. […] Your doctor might prescribe drugs including: Acyclovir (Sitavig, Zovirax), Cidofovir (Vistide), CMV immune globulin (CytoGam), Foscarnet (Foscavir), Ganciclovir (Cytovene), Leflunomide (Arava), Letermovir (Prevymis), Maribavir (Livtencity), Valganciclovir (Valcyte). […] These drugs generally can’t cure the disease, but they can help if you have a weak immune system and symptoms from a CMV infection. If you have advanced HIV, they can control the infection while you get antiretroviral therapy (ART) for your HIV infection.

• #12 Cytomegalovirus (CMV) Medication: Antivirals, Immune Globulin, Antimetabolite

  https://emedicine.medscape.com/article/215702-medication

  The goals of pharmacotherapy are to prevent outbreaks of the disease and its complications and to reduce morbidity. Several agents are available for the treatment of cytomegalovirus (CMV) infection and disease. […] In addition, multiple agents are being looked at for the treatment of CMV disease. These include (1) CMX001 (hexadecyloxypropyl-cidofovir, an ester of cidofovir), which is under development for ganciclovir-resistant CMV disease; (2) leflunomide, a pyrimidine synthesis inhibitor (Leflunomide has been successfully used in solid organ transplant recipients for both CMV treatment and prophylaxis. Unfortunately, leflunomide failure has been reported in hematopoietic stem cell transplant recipients); and (3) artesunate, an antimalarial with some in vitro activity against CMV. […] 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.

• #13 Cytomegalovirus (CMV) Medication: Antivirals, Immune Globulin, Antimetabolite

  https://emedicine.medscape.com/article/215702-medication

  Maribavir, a benzimidazole antiviral agent, has been used as salvage therapy in a small number of patients with multidrug-resistant CMV, but was unsuccessful when used as CMV prophylaxis in allogeneic stem cell transplant patients or in liver transplant recipients. […] Ganciclovir is considered the treatment of choice for CMV infections. […] Cidofovir is approved for the treatment of CMV retinitis in AIDS. […] Letermovir is indicated for prophylaxis of CMV infection and disease in adult CMV-seropositive recipients 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. […] Valganciclovir is used for CMV disease prophylaxis in various solid organ transplant recipients.

• #14 Cytomegalovirus Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4431713/

  In treating cytomegalovirus (CMV) infection, it is crucial to decide whether one is treating pre-emptively or if one is treating established disease. Disease may be further divided into viral syndrome and tissue-invasive disease. Generally, mild disease in immunosuppressed patients may be treated with oral valganciclovir. Treatment may also be started with valganciclovir for CMV retinitis in AIDS patients. In other tissue-invasive syndromes, starting with intravenous ganciclovir or foscarnet at full doses (adjusted for renal function) is preferred. Treatment at full doses should be continued until symptom resolution and until blood antigenemia (or DNAemia) is cleared. Patients receiving treatment must be closely monitored for side effects to the drugs, as well as for response. Drug-resistant CMV is a therapeutic challenge; combination therapy with both ganciclovir and foscarnet may be tried. In extreme cases, resorting to unconventional agents like leflunomide or maribavir may be necessary. Immune reconstitution, through reduction in immunosuppression, or the introduction of anti-retroviral therapy, should be attempted. CMX001 is a novel agent active against double-stranded viruses; thus far, resistance to CMX001 does not confer resistance to ganciclovir or foscarnet. Hence, prophylaxis or pre-emptive treatment with CMX001 may allow the use of ganciclovir or foscarnet for treatment.

• #15 Cytomegalovirus (CMV) Treatment & Management: Medical Care, Consultations, Activity

  https://emedicine.medscape.com/article/215702-treatment

  The drug of choice for the treatment of CMV disease is intravenous ganciclovir, although valganciclovir may be used for nonsevere CMV treatment in selected cases. […] Ganciclovir has been used to treat CNS disease, including encephalitis and neuropathy, with mixed results. […] Valganciclovir is used for treatment in selected CMV cases. […] A major successful use of ganciclovir has been prophylactic or preemptive treatment of CMV disease in transplant recipients. Without preventive CMV therapy, 30-75% of transplant recipients develop CMV infection, and 8-30% develop CMV disease. […] 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.

• #16 Cytomegalovirus Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4431713/

  The recommended treatment of CMV-p in the HSCT recipient is i.v. GCV with immunoglobulins. Although GCV reduced viral load by 99 % in the lungs of patients with CMV pneumonitis, nine of ten patients given i.v. GCV still died. However, the addition of immunoglobulins has reduced the mortality of CMV-p. […] The optimal treatment of CMV encephalitis/myelitis is undefined. Expert reviews favor a combination of i.v. GCV and FOS. This is based on an observational study from the pre-ART era. […] The first-line options for therapy of CMV disease, as mentioned above, are almost always i.v. GCV or p.o. VGC. However, in the early post-HSCT period, or in the severely neutropenic patient, one may have to start with FOS. […] Therapy of CMV disease should be started at full doses (adjusted for renal function) and continued until symptoms are clearly improved, and until antigenemia (or even DNAemia) has resolved.

• #17 Cytomegalovirus Disease: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/cytomegalovirus

  Cytomegalovirus end-organ disease is best prevented using ART to maintain the CD4 count 100 cells/mm3. […] The therapeutic approach to CMV retinitis should be individualized based on tolerance of systemic medications, prior exposure to anti-CMV drugs, and possibly the location of lesions. […] Oral valganciclovir, intravenous (IV) ganciclovir, or IV ganciclovir induction followed by oral valganciclovir maintenance are first-line therapies for treating CMV retinitis. […] Treatment with systemic anti-CMV therapy, such as oral valganciclovir for the first 3 to 6 months until ART has induced immune recovery, is beneficial. […] For patients who have colitis or esophagitis, many HIV specialists recommend anti-CMV therapy for 21 to 42 days or until signs and symptoms have resolved. […] IV ganciclovir generally is the therapy of choice and can be switched to oral valganciclovir once the patient can tolerate and absorb oral medications. […] Treatment experience for CMV pneumonitis in HIV patients is limited. Use of IV ganciclovir or IV foscarnet is reasonable. […] Treatment should be initiated promptly for CMV neurological disease. […] Combination of ganciclovir IV plus foscarnet IV to stabilize disease and maximize response.

• #18 Cytomegalovirus (CMV) — EACS Guidelines

  https://eacs.sanfordguide.com/eacs-part1/eacs-section4/ois/eacs-cytomegalovirus-cmv

  Cytomegalovirus (CMV) infections Contents Diagnosis and treatment Diagnosis: Retinitis:typical retinal lesions at ophthalmological examination AND response to therapy. Identification of CMV-DNA by NAT in of aqueous and vitreous humor optional Esophagitis/colitis:endoscopic presence of ulcerations AND typical histopathological picture (cellular / nuclear inclusion bodies) with identification of CMV antigens Encephalitis/polyradiculomyelitis:clinical appearance AND Identification of CMV-DNA by NAT in CSF Identification of CMV-DNA in blood supportive, but not diagnostic of end-organ disease […] Notes on treatment: monitor renal function and adjust drug dose in renal impairment. See also Anti-infective/ART interaction table […] Drug / Dose Comments Retinitis, Immediate sight-threatening lesions ganciclovir 5 mg/kg bid iv 3 weeks, then secondary prophylaxis OR foscarnet 90 mg/kg bid iv Foscarnet used as alternative therapy if toxicity or resistance to ganciclovir. Most experts would add intravitreal injections of ganciclovir(2 mg) or foscarnet(2.4 mg) for 1-4 doses over 7-10 days in combination with systemic CMV treatment Retinitis, small peripheral retinal lesions valganciclovir 900 mg bid po (with food) 2-3 weeks, then secondary prophylaxis OR ganciclovir 5 mg/kg bid iv OR foscarnet 90 mg/kg bid iv If adverse reactions or ineligibility to ganciclovir/valganciclovir Esophagitis/Colitis ganciclovir 5 mg/kg bid iv 3-6 weeks, until symptoms resolved, then secondary prophylaxis (switch to oral valganciclovir once tolerated) OR foscarnet 90 mg/kg bid iv OR valganciclovir 900 mg bid po (with food) In milder disease if oral treatment tolerated Encephalitis/Myelitis ganciclovir 5 mg/kg bid iv foscarnet 90 mg/kg bid iv Treat until symptoms resolved with clearance of CMV-DNA in CSF, then secondary prophylaxis Some experts recommend ganciclovir combined with foscarnet especially in progressive or relapsing cases Cidofovir (+ probenecid) may be considered as a therapeutic option for patients unable to tolerate the other treatments listed

• #19

  https://link.springer.com/article/10.1007/s40506-014-0021-5

  The treatment of CMV retinitis is guided by studies in patients with AIDS. The use of i.v. GCV, i.v. FOS, p.o. VGC, and the GCV implant are all supported by randomized controlled trial (RCT) data. […] The recommended treatment of CMV-p in the HSCT recipient is i.v. GCV with immunoglobulins. […] FOS is an alternative to i.v. GCV for CMV-p. […] The optimal treatment of CMV encephalitis/myelitis is undefined. Expert reviews favor a combination of i.v. GCV and FOS. […] The first-line options for therapy of CMV disease, as mentioned above, are almost always i.v. GCV or p.o. VGC. However, in the early post-HSCT period, or in the severely neutropenic patient, one may have to start with FOS. […] Therapy of CMV disease should be started at full doses (adjusted for renal function) and continued until symptoms are clearly improved, and until antigenemia (or even DNAemia) has resolved.

• #20 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/

  […] […] 5 Ganciclovir resistance […] CMV disease that is refractory to treatment with Ganciclovir or Valganciclovir is termed Ganciclovir resistance and is reported to occur in up to 3% of SOT recipients [1, 2]. Ganciclovir resistance may be suspected in difficult to control CMV infection, as evidenced by a persistent or increasing viral load or symptomatic disease after a normally effective dosage and duration (e.g.; 2-4 weeks) of Ganciclovir or Valganciclovir [3]. Although evidence is limited, prolonged antiviral courses, sub-therapeutic antiviral dosing, intensive immunosuppression, and T-cell depletion treatment are associated with an increased risk for developing Ganciclovir resistance, particularly in a solid organ transplant recipient receiving an organ from a CMV seropositive donor [2, 4-6].

• #21 Cytomegalovirus Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4431713/

  Reports of drug-resistant CMV in transplant patients are increasing. The risk factors have been covered in detail elsewhere. […] Although it is intuitive to use FOS for GCV-resistant CMV, published results are mixed. […] The other agents that have been tried in the literature are artesunate, maribavir (MBV), and leflunomide. […] CMX001 (hexadecyloxypropyl CDV) is an orally available lipid acyclic nucleotide phosphonate that delivers high intracellular levels of CDV-diphosphate. Early human studies showed no significant effects on blood chemistries or hematology.

• #22 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

  New Treatment Options for Refractory/Resistant CMV Infection […] Despite advances in monitoring and treatment, cytomegalovirus (CMV) infections remain one of the most common complications after solid organ transplantation (SOT). CMV infection may fail to respond to standard first- and second-line antiviral therapies with or without the presence of antiviral resistance to these therapies. This failure to respond after 14 days of appropriate treatment is referred to as “resistant/refractory CMV.” Limited data on refractory CMV without antiviral resistance are available. Reported rates of resistant CMV are up to 18% in SOT recipients treated for CMV. Therapeutic options for treating these infections are limited due to the toxicity of the agent used or transplant-related complications. This is often the challenge with conventional agents such as ganciclovir, foscarnet and cidofovir. Recent introduction of new CMV agents including maribavir and letermovir as well as the use of adoptive T cell therapy may improve the outcome of these difficult-to-treat infections in SOT recipients. In this expert review, we focus on new treatment options for resistant/refractory CMV infection and disease in SOT recipients, with an emphasis on maribavir, letermovir, and adoptive T cell therapy.

• #23 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 this review, we summarize and discuss the latest findings on maribavir, letermovir, and CMV-specific adoptive T cell therapies as treatment options for R/R CMV after SOT. […] Maribavir is an oral benzimidazole riboside antiviral which has been in development for many years, but only recently became available as therapy for R/R CMV. It inhibits viral UL97 kinase and thus interferes with multiple pathways including nuclear egress of CMV viral capsids. It has no significant renal, hematologic, or hepatic toxicity; its most common adverse effect is dysgeusia. Early trials for prophylaxis in stem cell transplant and liver transplant recipients failed to show efficacy, likely because the dose selected, 100 mg twice daily, was too low. However, a case series of six patients with R/R CMV treated with compassionate use maribavir at doses of 400–800 mg twice daily showed striking responses in several patients. This, and the toxicity of other agents available for R/R CMV, spurred the performance of a Phase 2 trial of 3 dosing regimens for maribavir (400, 800, and 1,200 mg twice daily) among SOT and HSCT recipients. This study demonstrated clearance of CMV DNAemia at 6 weeks of therapy in 70%, 63%, and 68%, respectively, in this highly treatment-experienced population.

• #24 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

  Subsequently, a multicenter Phase 3 trial of maribavir versus investigator-assigned therapy (IAT) was performed involving 352 SOT and HSCT recipients in a 2:1 randomization. IAT, which could be ganciclovir, valganciclovir, foscarnet, cidofovir, or a combination of these, was chosen as the comparator because of patients’ varied treatment histories. The primary endpoint, confirmed CMV-DNA clearance at the end of week 8, was achieved by 55.7% in the maribavir arm vs. 23.9% in the IAT arm. The key secondary endpoint, a composite of CMV-DNA clearance and symptom control at the end of week 8 maintained through week 16, was achieved by 18.7% vs. 10.3%. Dysgeusia was the most frequent adverse effect in the maribavir group (37.2%); the maribavir group also had significantly less neutropenia than the val/ganciclovir group and less acute kidney injury than the foscarnet group. These results led to the approval of maribavir by the US FDA in 2021 for treatment of post-transplant CMV infection/disease in patients age 12 and older, that is refractory (with or without genotypic resistance) to treatment with ganciclovir, valganciclovir, cidofovir or foscarnet, with a similar authorization by the EMA in 2022.

• #25 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

  While the approval of maribavir for R/R CMV was long-awaited, questions about optimal use remain. In the Phase 3 R/R CMV trial, subgroup analyses showed that the proportion achieving the primary endpoint was higher when maribavir was initiated at a viral load of <9100 IU/mL than at higher viral loads (62.1% vs. 43.9%), and was higher with documented genotypic resistance vs. refractory CMV without resistance (62.8% vs. 43.8%). Some experts have proposed that R/R CMV with high viral load might most effectively be treated with an agent such as foscarnet initially, then switch over to maribavir at a lower viral load, to minimize foscarnet toxicity and to maximize the efficacy of maribavir. [...] Letermovir is a 3,4-dihydroquinazoline derivative and is an inhibitor of the viral terminase complex, mainly at the pUL56 subunit. Terminase inhibition leads to compromised viral replication by inhibiting the cleavage of genome particles to units of proper length and accumulation of immature viral DNA. Based on the mechanism of action, letermovir is selectively active only against CMV, and mechanism-derived adverse effects are unlikely. Letermovir was approved in 2017 for prophylactic use in adult CMV-seropositive allogeneic hematopoietic stem cell transplant (HCT) recipients, where it has shown good efficacy in the placebo-controlled phase III trial and as of 6 June 2023, the US FDA approved letermovir for the new indication of CMV prophylaxis in D+/R− kidney transplant recipients, based on the results of the Phase 3 trial.

• #26 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+/R− 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%). […] In summary, R/R CMV remains a major challenge and new effective and safe treatment options are needed. Best evidence on efficacy and safety is available for maribavir and we therefore recommend maribavir as first-line treatment for R/R CMV in SOT. However, although maribavir was superior to standard therapies for R/R CMV, many patients did not achieve sustained viral clearance and symptom control.

• #27 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/

  Genotypic assays can, relatively rapidly, detect gene mutations that are associated with both high and low-grade resistance to ganciclovir, as well as other mutations that confer various degrees of resistance to Ganciclovir, Foscarnet and Cidofovir. The committee agreed that resistance testing should be performed by automated sequencing methods using genotypic assays to identify specific resistance mutations in the UL97 and UL54 genes, since these are the two most widely described causes of Ganciclovir resistance. […] Newer agents Letermovir and Maribavir may be associated with less drug resistance than Ganciclovir. The use of Maribavir for treating refractory or resistant CMV infection following solid organ transplantation has been assessed in phase 3 studies and reported to be superior to Ganciclovir, Cidofovir and Foscarnet [10, 11]. Maribavir has Food and Drugs Administration (FDA) and MHRA [12] approval and is now recommended by the National Institute for Health and Care Excellence (NICE) for the treatment of CMV infection and / or disease that are refractory (with or without resistance) to one or more prior therapies, including valganciclovir, ganciclovir, cidofovir and foscarnet in adults who have undergone a solid organ transplant [13]. Treatment duration may need to be individualised based on clinical characteristics. For children and young people, treatment with Maribavir would be outside of its marketing authorisation. The committee had agreed to review the outcome of this Technology Appraisal Guidance once published in January 2023 and therefore updated the guideline in May 2023 to include a recommendation on Maribavir for suspected or confirmed CMV resistance, as set out in the recommendations. Committee members noted the importance of reporting and suspected adverse reactions via the national reporting system (www.mhra.gov.uk/yellowcard).

• #28 Treatment of congenital cytomegalovirus infection

  https://www.e-cep.org/journal/view.php?number=20125555586

  Congenital cytomegalovirus (CMV) is the most common cause of congenital infection worldwide, the most common nongenetic cause of sensorineural hearing loss in children, and a cause of neurodevelopmental disorders in the brain. Infants with symptomatic congenital CMV infection may benefit from hearing and neurodevelopmental outcomes, particularly if antiviral treatment is initiated within the first month of life. Infants with life-threatening symptoms are recommended to receive 26 weeks of intravenous ganciclovir and then switch to oral valganciclovir, and those without life-threatening symptoms are recommended to use oral valganciclovir during the entire 6-month period. […] This review investigated the evidence to date of treating congenital CMV infection. […] Congenital CMV is initially treated with intravenous ganciclovir for 26 weeks and switched to oral valganciclovir, or with oral valganciclovir for the entire 6-month period. Infants with congenital CMV require periodic monitoring of absolute neutrophil count, platelet count, and blood urea nitrogen, creatinine, liver function tests, audiological, ophthalmological, and developmental tests during antiviral medication.

• #29 Cytomegalovirus (CMV) Infection: Causes & Symptoms

  https://my.clevelandclinic.org/health/diseases/21166-cytomegalovirus

  A provider can treat CMV with the antiviral medications ganciclovir (GCV) or valganciclovir (VGC). These drugs are given directly into your vein (IV infusion) or swallowed in a pill. Providers usually only treat CMV in people who have a compromised immune system or babies who are born with symptoms of CMV. In people with healthy immune systems, CMV usually goes away without treatment. […] Antiviral medications cant reverse any damage thats already been done. They can lessen the risk of health problems in babies born with CMV but may not completely prevent them. Children with congenital CMV can also be treated with speech and occupational therapy to manage the effects of hearing loss and developmental issues.

• #30 Treatment of congenital cytomegalovirus infection

  https://www.e-cep.org/journal/view.php?number=20125555586

  Antiviral treatment is recommended in infants with congenital CMV infection and end-organ symptoms in one or more organs or evidence of CNS involvement. Treatment with intravenous ganciclovir and oral valganciclovir in infants with these symptoms improves long-term hearing and neurodevelopmental outcomes. […] The current standard treatment period for infants with congenital CMV infection and symptoms is 6 months based on oral valganciclovir. […] Infants with severe symptoms are monitored for CMV DNAemia, and antiviral treatment is administered if the viremia does not resolve after 6 months. […] The currently recommended drug regimen for symptomatic infants with congenital CMV infection is as follows: infants with life-threatening symptoms are initially treated with intravenous ganciclovir for 26 weeks and then switched to oral valganciclovir, while those without life-threatening symptoms are treated with oral valganciclovir for the entire 6-month period. Monitoring of ANC, platelet count, blood urea nitrogen, creatinine, and liver function tests is required to identify neutropenia, thrombocytopenia, renal failure, and liver failure during antiviral treatment.

• #31 Treatment of congenital cytomegalovirus infection

  https://www.e-cep.org/journal/view.php?doi=10.3345/cep.2022.01032

  Congenital cytomegalovirus (CMV) is the most common cause of congenital infection worldwide, the most common nongenetic cause of sensorineural hearing loss in children, and a cause of neurodevelopmental disorders in the brain. Infants with symptomatic congenital CMV infection may benefit from hearing and neurodevelopmental outcomes, particularly if antiviral treatment is initiated within the first month of life. Infants with life-threatening symptoms are recommended to receive 26 weeks of intravenous ganciclovir and then switch to oral valganciclovir, and those without life-threatening symptoms are recommended to use oral valganciclovir during the entire 6-month period. […] This review investigated the evidence to date of treating congenital CMV infection. […] Congenital CMV is initially treated with intravenous ganciclovir for 26 weeks and switched to oral valganciclovir, or with oral valganciclovir for the entire 6-month period. Infants with congenital CMV require periodic monitoring of absolute neutrophil count, platelet count, and blood urea nitrogen, creatinine, liver function tests, audiological, ophthalmological, and developmental tests during antiviral medication. […] Antiviral treatment is recommended in infants with congenital CMV infection and end-organ symptoms in one or more organs or evidence of CNS involvement. Treatment with intravenous ganciclovir and oral valganciclovir in infants with these symptoms improves long-term hearing and neurodevelopmental outcomes.

• #32 Treatment of congenital cytomegalovirus infection

  https://www.e-cep.org/journal/view.php?doi=10.3345/cep.2022.01032

  The current standard treatment period for infants with congenital CMV infection and symptoms is 6 months based on oral valganciclovir. A randomized controlled study by Kimberlin et al. showed better hearing and neurodevelopmental prognosis in the oral valganciclovir 6-month use group; thereafter, oral valganciclovir 6-month treatment became the standard. However, infants with persistent viremia, retinitis, liver disease, and primary immune disorders may require oral valganciclovir therapy beyond 6 months of age. […] The currently recommended drug regimen for symptomatic infants with congenital CMV infection is as follows: infants with life-threatening symptoms are initially treated with intravenous ganciclovir for 26 weeks and then switched to oral valganciclovir, while those without life-threatening symptoms are treated with oral valganciclovir for the entire 6-month period. Monitoring of ANC, platelet count, blood urea nitrogen, creatinine, and liver function tests is required to identify neutropenia, thrombocytopenia, renal failure, and liver failure during antiviral treatment.

• #33 Cytomegalovirus (CMV) – congenital and postnatal infection | NHSGGC

  https://clinicalguidelines.scot.nhs.uk/ggc-paediatric-guidelines/ggc-paediatric-guidelines/neonatology/cytomegalovirus-cmv-congenital-and-postnatal-infection/

  There is now sufficient evidence to recommend treatment of infants with symptomatic congenital CMV who have evidence of neurological involvement, as this may improve outcomes for hearing and neurodevelopment. […] Recent research suggests that the best outcomes result from a 6 month course of treatment when compared with earlier regimens which used a shorter course of 6 weeks. […] Oral valganciclovir is first line treatment and IV ganciclovir should only be used if oral medication is not tolerated or if there is severe disease and absorption is uncertain. […] Ganciclovir 6mg/kg twice daily by intravenous infusion (central line). […] Change to oral valganciclovir 16mg/kg twice daily (unless renal impairment) when the infant is on approximately 50% enteral feeds. […] Valganciclovir 16mg/kg/dose twice daily by mouth (unless renal impairment).

• #34 Congenital Cytomegalovirus Infection: Update on Diagnosis and Treatment

  https://www.mdpi.com/2076-2607/8/10/1516

  Congenital cytomegalovirus (cCMV) infection is the most common congenital viral infection and is the leading non-genetic cause of sensorineural hearing loss (SNLH) and an important cause of neurodevelopmental disabilities. […] Despite its prevalence and morbidity among the neonatal population, there is not yet a standardized diagnostic test and therapeutic approach for cCMV infection. […] Currently, we recommend using a PCR assay in blood, urine, and saliva in neonates with suspected cCMV infection. […] In the case of symptomatic cCMV, we actually recommend treatment with oral valganciclovir for a duration of 12 months. […] The effectiveness and tolerability of this therapy option have proven effective for hearing and neurodevelopmental long-term outcomes. […] Valganciclovir is reserved for congenitally-infected neonates with the symptomatic disease at birth, such as microcephaly, intracranial calcifications, abnormal cerebrospinal fluid index, chorioretinitis, or sensorineural hearing loss.

• #35 Congenital Cytomegalovirus Infection: Update on Diagnosis and Treatment

  https://www.mdpi.com/2076-2607/8/10/1516

  Treatment with antiviral drugs is not routinely recommended for neonates with the mildly symptomatic disease at birth, for neonates under 32 weeks of gestational age, or for infants more than 30 days old because of insufficient evidence from studies. […] However, since these populations represent the vast majority of neonates and infants with cCMV infection and they are at risk of developing late-onset sequelae, a biomarker able to predict long-term sequelae should also be found to justify starting treatment and reducing the burden of CMV-related complications.

• #36 Antiviral Treatment of Maternal and Congenital Cytomegalovirus (CMV) Infections

  https://www.mdpi.com/1999-4915/15/10/2116

  Antiviral Treatment of Maternal and Congenital Cytomegalovirus (CMV) Infections […] Human Cytomegalovirus (HCMV) is a ubiquitous member of the Herpesviridae family, responsible for the most common congenital viral infection—congenital Cytomegalovirus (cCMV) infection. […] This review will focus on antiviral treatment options currently available for use during pregnancy and in the newborn period for the treatment of maternal and congenital HCMV infections. […] Several intervention strategies aimed at preventing maternal–fetal transmission in primary HCMV infections have been studied, including behavioral risk reduction measures, HCMV hyperimmune globulin (HIG), and antiviral therapies. […] Due to the complexities of definitively diagnosing non-primary HCMV infections and the lack of tools to identify those with non-primary infection at increased risk for intrauterine transmission, interventions to prevent maternal–fetal HCMV transmission in this scenario are nonexistent.

• #37 Antiviral Treatment of Maternal and Congenital Cytomegalovirus (CMV) Infections

  https://www.mdpi.com/1999-4915/15/10/2116

  Recent studies have shown the effectiveness of valacyclovir treatment in primary maternal HCMV infections to prevent fetal HCMV infection, as discussed below. […] While antiviral treatment with valganciclovir is currently only reserved for infants with symptomatic cCMV to improve hearing and neurodevelopmental outcomes, due to associated toxicities, secondary and tertiary interventions during pregnancy using this agent are not currently recommended. […] One randomized clinical trial and several observational cohort studies have been performed to determine the efficacy of oral valacyclovir in preventing maternal–fetal HCMV transmission in primary HCMV infections. […] The drug was overall well tolerated with minimal side effects (thrombocytopenia, nausea, headache, and abdominal pain).

• #38

  https://www.nationalcmv.org/overview/interventions-therapies

  Emerging research shows that antiviral drugs, Ganciclovir or Valganciclovir, may help newborns born with symptomatic congenital CMV or those who are asymptomatic with isolated hearing loss. […] These antiviral treatments may prevent or lessen the severity of hearing loss. […] Ganciclovir and Valganciclovir can also help combat immediate medical concerns caused by congenital CMV, such as thrombocytopenia, organ failure (most commonly spleen and/or liver), hepatitis, and pneumonitis. […] Treatments generally last from 6 weeks to 6 months and are administered orally or through an IV or PICC line. […] Both Ganciclovir and Valganciclovir can have serious side effects, so be sure to consult with a doctor before beginning treatment and during the antiviral treatment period. […] Previous studies indicated that Cytomegalovirus Hyperimmune Globulin Intravenous (CMV-IGIV), or Cytogam, treatment may lessen or reduce the risk of congenital infection and/or neonatal disease when given to pregnant women experiencing a primary CMV infection.

• #39

  https://www.nationalcmv.org/overview/interventions-therapies

  Cytogam is an immunoglobulin G (IgG) containing antibodies to CMV. […] Newly published data per a randomized controlled trial funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Center for Advancing Translating Sciences suggests that „administering hyperimmune globulin to pregnant women who tested positive for CMV did not reduce CMV infections or deaths among their fetuses or newborns…and should not be used for the prevention of cCMV in pregnant patients with primary CMV during pregnancy”. […] Larger trials are necessary for other safe and effective antiviral treatments, for example high-dose valacyclovir in early pregnancy, or newer immunoglobulin products, such as monoclonal antibodies. […] Until then, we must advocate for the prioritization of a CMV vaccine. […] If you would like more information about active clinical trials, anti-viral therapy and other CMV treatment options, please speak with your doctor.

• #40 Management of cytomegalovirus infection after liver transplantation

  https://www.wjgnet.com/2220-3230/full/v14/i3/93209.htm

  Cytomegalovirus (CMV) infection is one of the primary causes of morbidity and mortality following liver transplantation (LT). Based on current worldwide guidelines, the most effective strategies for avoiding post-transplant CMV infection are antiviral prophylaxis and pre-emptive treatment. […] The comprehensive management of CMV infection spans prevention, treatment, diagnosis, immunology, drug resistance, and pediatric issues. […] Prevention and management of CMV infection after LT are crucial to improve outcomes. […] Universal prophylaxis and pre-emptive treatment are the main approaches to prevent CMV after solid organ transplantation. […] For universal prophylaxis, 36 mo of prophylaxis is recommended for all at-risk LT recipients (except D/R). Prophylaxis begins within 10 d after LT, and valganciclovir is generally used in this setting.

• #41 Management of cytomegalovirus infection after liver transplantation

  https://www.wjgnet.com/2220-3230/full/v14/i3/93209.htm

  Weekly CMV DNAemia monitoring and the initiating of antiviral therapy when the viral load exceeds a predetermined threshold constitute a pre-emptive strategy. […] The primary antiviral drugs used in the treatment of CMV disease are intravenous ganciclovir and oral valganciclovir. […] The choice of antiviral therapy depends on factors such as the patients renal function, drug interactions, and the presence of drug resistance. […] Currently, the first-line treatment of CMV infection starts with intravenous ganciclovir at a dose of 5 mg/kg twice daily, continued for at least 2 wk. […] Maribavir has recently been approved in the USA and Europe for the treatment of R/R CMV.

• #42 Cytomegalovirus (CMV) Treatment & Management: Medical Care, Consultations, Activity

  https://emedicine.medscape.com/article/215702-treatment

  There are various CMV-treatment approaches based on the patients CMV status and co-morbidities. Some patients receive prophylaxis whereas some receive preemptive therapy. Prophylaxis is given to a patient to prevent primary, reactivation, or recurrent infection. Preemptive therapy is given to asymptomatic CMV-infected patients with CMV detected by screening tests. Some studies have shown that high-dose acyclovir or valacyclovir prophylaxis markedly reduces CMV infection in allo-HSCT recipients. Intravenous ganciclovir also has been tested, with some reduction in CMV infection; however, this did not provide overall survival benefit and was associated with bone marrow suppression (ganciclovir-induced neutropenia). […] 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.

• #43 Cytomegalovirus (CMV) Treatment & Management: Medical Care, Consultations, Activity

  https://emedicine.medscape.com/article/215702-treatment

  The drug of choice for the treatment of CMV disease is intravenous ganciclovir, although valganciclovir may be used for nonsevere CMV treatment in selected cases. […] Ganciclovir has been used to treat CNS disease, including encephalitis and neuropathy, with mixed results. […] Valganciclovir is used for treatment in selected CMV cases. […] A major successful use of ganciclovir has been prophylactic or preemptive treatment of CMV disease in transplant recipients. Without preventive CMV therapy, 30-75% of transplant recipients develop CMV infection, and 8-30% develop CMV disease. […] 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.

• #44 Cytomegalovirus (CMV): symptoms, treatments and diagnosis

  https://www.kidneyresearchuk.org/conditions-symptoms/cytomegalovirus/

  Transplant units will generally use preventative and/or pre-emptive therapies to minimise the impact of CMV. […] To prevent CMV infection, Doctors will prescribe antiviral medicines, taken orally, for around three to six months after a transplant. The amount of time a person will receive this preventative medicine for depends on their risk of getting a CMV infection and the intensity of their immunosuppression treatment. However, sometimes people can get a CMV infection after stopping these medicines. […] With pre-emptive therapy, transplant recipients are regularly monitored and are given antiviral medicines as soon as they are judged to be at risk of developing a CMV infection. […] If a person does go on to develop a CMV infection their antiviral medication will be given at a treatment dose, or may need to be delivered directly into the bloodstream through an IV line if oral tablets are not possible. […] These medicines, combined with the lowering of immunosuppression, can effectively treat CMV and reduce the chance of serious problems.

• #45 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 to treat CMV Prophylaxis. […] valacyclovir to treat CMV Prophylaxis. […] valganciclovir to treat CMV Prophylaxis. […] ganciclovir systemic. […] letermovir to treat CMV Prophylaxis. […] Prevymis to treat CMV Prophylaxis. […] cytomegalovirus immune globulin systemic.

• #46 Cytomegalovirus (CMV) Treatment & Management: Medical Care, Consultations, Activity

  https://emedicine.medscape.com/article/215702-treatment

  Letermovir is indicated for prophylaxis of CMV infection and disease in adult CMV-seropositive recipients [R+] of an allogeneic hematopoietic stem cell transplant (HSCT). […] CMV immune globulin has been approved by the US Food and Drug Administration for the prophylaxis of CMV disease in high-risk lung transplant recipients when given in conjunction with ganciclovir.

• #47 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

  While the approval of maribavir for R/R CMV was long-awaited, questions about optimal use remain. In the Phase 3 R/R CMV trial, subgroup analyses showed that the proportion achieving the primary endpoint was higher when maribavir was initiated at a viral load of <9100 IU/mL than at higher viral loads (62.1% vs. 43.9%), and was higher with documented genotypic resistance vs. refractory CMV without resistance (62.8% vs. 43.8%). Some experts have proposed that R/R CMV with high viral load might most effectively be treated with an agent such as foscarnet initially, then switch over to maribavir at a lower viral load, to minimize foscarnet toxicity and to maximize the efficacy of maribavir. [...] Letermovir is a 3,4-dihydroquinazoline derivative and is an inhibitor of the viral terminase complex, mainly at the pUL56 subunit. Terminase inhibition leads to compromised viral replication by inhibiting the cleavage of genome particles to units of proper length and accumulation of immature viral DNA. Based on the mechanism of action, letermovir is selectively active only against CMV, and mechanism-derived adverse effects are unlikely. Letermovir was approved in 2017 for prophylactic use in adult CMV-seropositive allogeneic hematopoietic stem cell transplant (HCT) recipients, where it has shown good efficacy in the placebo-controlled phase III trial and as of 6 June 2023, the US FDA approved letermovir for the new indication of CMV prophylaxis in D+/R− kidney transplant recipients, based on the results of the Phase 3 trial.

• #48 Cytomegalovirus Disease: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/cytomegalovirus

  Cytomegalovirus end-organ disease is best prevented using ART to maintain the CD4 count 100 cells/mm3. […] The therapeutic approach to CMV retinitis should be individualized based on tolerance of systemic medications, prior exposure to anti-CMV drugs, and possibly the location of lesions. […] Oral valganciclovir, intravenous (IV) ganciclovir, or IV ganciclovir induction followed by oral valganciclovir maintenance are first-line therapies for treating CMV retinitis. […] Treatment with systemic anti-CMV therapy, such as oral valganciclovir for the first 3 to 6 months until ART has induced immune recovery, is beneficial. […] For patients who have colitis or esophagitis, many HIV specialists recommend anti-CMV therapy for 21 to 42 days or until signs and symptoms have resolved. […] IV ganciclovir generally is the therapy of choice and can be switched to oral valganciclovir once the patient can tolerate and absorb oral medications. […] Treatment experience for CMV pneumonitis in HIV patients is limited. Use of IV ganciclovir or IV foscarnet is reasonable. […] Treatment should be initiated promptly for CMV neurological disease. […] Combination of ganciclovir IV plus foscarnet IV to stabilize disease and maximize response.

• #49 Cytomegalovirus | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0201/p519.html

  Cytomegalovirus (CMV) is a prevalent viral pathogen. […] Severe illness can occur after reactivation of the latent virus in immunosuppressed persons. […] Advances in the treatment of human immunodeficiency virus infection with highly active antiretroviral therapy (HAART) have decreased the incidence of CMV retinitis but have resulted in a new set of ophthalmologic complications induced by restoration of immune competency and the pro-inflammatory response of the patient to CMV. […] If HAART restores the patient’s CD4 cell count to above 100 to 150 per mm3 (100 to 150 106 per L), it may preclude lifelong treatment for CMV retinitis. […] The destruction of the retina, which causes irreversible blindness, can be arrested and suppressed by anti-CMV agents. […] These medications halt CMV replication but do not eliminate the virus.

• #50 Cytomegalovirus Disease: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/cytomegalovirus

  Cytomegalovirus end-organ disease is best prevented using ART to maintain the CD4 count 100 cells/mm3. […] The therapeutic approach to CMV retinitis should be individualized based on tolerance of systemic medications, prior exposure to anti-CMV drugs, and possibly the location of lesions. […] Oral valganciclovir, intravenous (IV) ganciclovir, or IV ganciclovir induction followed by oral valganciclovir maintenance are first-line therapies for treating CMV retinitis. […] Treatment with systemic anti-CMV therapy, such as oral valganciclovir for the first 3 to 6 months until ART has induced immune recovery, is beneficial. […] For patients who have colitis or esophagitis, many HIV specialists recommend anti-CMV therapy for 21 to 42 days or until signs and symptoms have resolved. […] IV ganciclovir generally is the therapy of choice and can be switched to oral valganciclovir once the patient can tolerate and absorb oral medications. […] Treatment experience for CMV pneumonitis in HIV patients is limited. Use of IV ganciclovir or IV foscarnet is reasonable. […] Treatment should be initiated promptly for CMV neurological disease. […] Combination of ganciclovir IV plus foscarnet IV to stabilize disease and maximize response.

• #51 Cytomegalovirus (CMV): Symptoms, Causes, Treatment

  https://www.webmd.com/hiv-aids/aids-hiv-opportunistic-infections-cytomegalovirus

  Most importantly, if you take ART early in an HIV infection, the drugs will keep it from getting worse and will keep you from getting CMV in the first place. […] If you have retinitis because of CMV, your doctor may give you strong medications intravenously (through a vein) for a couple of weeks, a process called induction therapy. After a while, they may switch you to pills.

• #52 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).

• #53 Cytomegalovirus: Pediatric OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-pediatric-opportunistic-infections/cytomegalovirus

  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).

• #54 Cytomegalovirus: Pediatric OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-pediatric-opportunistic-infections/cytomegalovirus

  Discontinuation of secondary prophylaxis may be considered for children who are receiving ART and have a sustained (e.g., 6 months) increase in CD4 count, defined as an increase in CD4 percentage to 15% for children aged 6 years, or an increase in CD4 count to 100 cells/mm3 for children aged 6 years (weak, low).

• #55 Cytomegalovirus (CMV) Infection – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/herpesviruses/cytomegalovirus-cmv-infection

  With any of the maintenance regimens, clinicians can consider stopping maintenance therapy after 3 months of CMV therapy in HIV-infected patients who are taking antiretroviral therapy (ART) and have had a CD4 count of 100 cells/mL for 3 months. […] Intravitreal antiviral therapy should be used in combination with systemic therapy for patients with CMV retinitis that immediately threatens sight. […] Prophylaxis or preemptive treatment (actively monitoring patients by viral load and giving antivirals to those with evidence of infection) is effective for preventing CMV disease in solid organ or hematopoietic cell transplant recipients infected with CMV and at risk of CMV disease.

• #56 Cytomegalovirus – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459185/

  Several antiviral agents have been approved for the treatment of CMV (cidofovir, foscarnet, ganciclovir, valganciclovir). […] Immunocompetent patients present with minimal or no symptoms and are self-limited and do not require specific therapy other than symptomatic management. However, antiviral therapy should be considered in severe cases of CMV mononucleosis, CMV infection, and CMV disease in immunocompromised patients. […] The use of antiviral therapy is not without risk. Toxicity is common with the use of these agents and must be weighed against the benefits of initiating treatment. […] Patients without CMV infection who receive organ transplants from CMV-infected donors should receive prophylactic treatment with valganciclovir or ganciclovir, and regular serological monitoring; if treated, the early establishment of a potentially life-threatening infection can be avoided.

• #57 Cytomegalovirus (CMV) Infection: Symptoms, Treatment, Pregnancy

  https://www.medicinenet.com/cytomegalovirus_cmv/article.htm

  What is the treatment for cytomegalovirus? […] There is no cure for CMV, and treatment for CMV infection is not necessary for healthy children and adults. Those at very high risk of developing severe CMV infection may be placed on antiviral medication to help prevent CMV disease. This pretreatment is called prophylaxis. This method has helped reduce the number of CMV infections in these patients. […] The antiviral medications against CMV include the following: Ganciclovir (Cytovene) is the first antiviral medication approved for the treatment of CMV infection. Ganciclovir, given intravenously, is the drug of choice for the treatment of CMV infection. Side effects include fever, rash, diarrhea, anemia, and low white blood cell and platelet counts. […] Valganciclovir (Valcyte) is an oral medication that is activated to ganciclovir in the body and is widely used to prevent CMV infection (prophylaxis). It is used in selected patients for the treatment of CMV infection and is as effective as intravenous ganciclovir in milder cases.

• #58 Cytomegalovirus (CMV) Infection: Symptoms, Treatment, Pregnancy

  https://www.medicinenet.com/cytomegalovirus_cmv/article.htm

  Foscarnet (Foscavir) is active against CMV by a different mechanism than ganciclovir and is used to treat infections with CMV that are resistant to ganciclovir. It is a second-line therapy for patients who do not tolerate ganciclovir treatment. Foscarnet is toxic to the kidneys and can cause seizures due to an imbalance of minerals and electrolytes. […] Cidofovir (Vistide) is an alternative therapy for patients who have failed ganciclovir and foscarnet treatment. Its use is limited due to toxicity to the kidneys. It is used mainly for the treatment of CMV infection of the eye (retinitis) in patients with acquired immune deficiency syndrome (AIDS) caused by the human immunodeficiency virus (HIV). […] CMV immune globulin contains antibodies (proteins) that are specific to CMV. It may be prescribed to prevent CMV infection in high-risk lung transplant patients when given in addition to ganciclovir. It is also used with ganciclovir to treat CMV pneumonia.

• #59 CMV (Cytomegalovirus): Symptoms & Treatment | Alpine BioMedical

  https://alpine-biomedical.ch/en/blog/cmv/

  The treatment of a CMV infection depends on the severity of the infection and the immune status of the affected person. While healthy people with a functioning immune system generally do not require special therapy, the infection can have serious consequences for newborns or immunocompromised individuals. In such cases, both conventional medical and complementary medicine approaches are used. […] In severe cases or in immunocompromised patients, antiviral therapy with virostatics is used to inhibit viral replication. Commonly used active substances include: Ganciclovir: Primarily used in immunosuppressed patients and severe CMV infections. It inhibits viral replication but may cause side effects such as impaired blood cell formation. […] Valganciclovir: An oral form of ganciclovir, frequently used for CMV retinitis or congenital CMV infection.

• #60 CMV (Cytomegalovirus): Symptoms & Treatment | Alpine BioMedical

  https://alpine-biomedical.ch/en/blog/cmv/

  Foscarnet: An alternative for patients who cannot tolerate ganciclovir or in whom resistance has developed. […] Cidofovir: Used in severe CMV infections, particularly when other medications are not sufficiently effective. […] Additionally, symptomatic treatment is provided to alleviate existing complaints. This includes antipyretic medications (such as paracetamol or ibuprofen) for fever, as well as pain-relieving medications to counteract headaches and sore throats. If the CMV infection causes inflammation, anti-inflammatory medications are used to reduce it. Furthermore, fluid replacement is very important to counter potential fluid loss. […] In immunocompromised patients, possible complications such as pneumonia or rhinitis must be treated specifically. In certain cases, therapy with immunoglobulins may also be beneficial to support the weakened immune system.

• #61 Cytomegalovirus (CMV) Medication: Antivirals, Immune Globulin, Antimetabolite

  https://emedicine.medscape.com/article/215702-medication

  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 is used for CMV pneumonia treatment. […] Leflunomide has been used off-label in the treatment of cytomegalovirus (CMV) disease in transplant recipients, as well as in the prevention of acute and chronic rejection in recipients of solid organ transplants.

• #62

  https://journals.lww.com/transplantjournal/fulltext/2016/03001/cmv_immunoglobulins_for_the_treatment_of_cmv.2.aspx

  Intravenous ganciclovir and, increasingly, oral valganciclovir are now considered the mainstay of treatment for cytomegalovirus (CMV) infection or CMV disease. […] Under certain circumstances, CMV immunoglobulin (CMVIG) may be an appropriate addition or, indeed, alternative. […] In cases of recurrent CMV in thoracic transplant patients after a disease- and drug-free period, adjunctive CMVIG can be considered in patients with hypogammaglobulinemia. […] Antiviral-resistant CMV, which is more common among thoracic organ recipients than in other types of transplant, can be an indication for introduction of CMVIG, particularly in view of the toxicity associated with other options, such as foscarnet. […] In the absence of a robust evidence base, it seems reasonable to consider the use of CMVIG to treat CMV in adult or pediatric thoracic transplant patients with ganciclovir-resistant infection, or in serious or complicated cases.

• #63

  https://journals.lww.com/transplantjournal/fulltext/2016/03001/cmv_immunoglobulins_for_the_treatment_of_cmv.2.aspx

  There are circumstances where the use of CMV immunoglobulin (CMVIG) may be an appropriate addition to ganciclovir and valganciclovir administration, although data are currently highly limited. […] Some centers use CMVIG off-label to support the treatment of CMV infection or disease, for example, in patients with hypogammaglobulinemia, in the event of ganciclovir resistance, or in the event of tissue-invasive disease. […] Although antiviral agents remain the cornerstone for routine management of CMV infection or CMV disease, CMVIG has been used as an alternative in asymptomatic cases. […] Intolerance to antiviral therapy can also represent a suitable occasion for introduction of CMVIG. […] In cases of recurrent CMV in thoracic transplant patients after a disease- and drug-free period, adjunctive CMVIG can be considered in patients with hypogammaglobulinemia.

• #64

  https://journals.lww.com/transplantjournal/fulltext/2016/03001/cmv_immunoglobulins_for_the_treatment_of_cmv.2.aspx

  The use of CMVIG to treat CMV in adult or pediatric thoracic transplant patients appears to be most appropriate for ganciclovir-resistant infection or in serious or complicated cases. […] There is no consensus on the optimal CMVIG regimen when used as a treatment for CMV infection or CMV disease, but dosages are higher than for prophylactic use, with 200 to 400 mg/kg being typical.

• #65

  https://link.springer.com/article/10.1007/s40506-014-0021-5

  The earliest large study that demonstrated non-inferiority of p.o. VGC to i.v. GCV was conducted in AIDS patients with CMV retinitis, and p.o. VGC was found to be as effective as i.v. GCV as induction therapy. […] Reports of drug-resistant CMV in transplant patients are increasing. […] In such circumstances, a sample of blood or tissue should be sent for CMV drug-resistance genotyping. […] Although it is intuitive to use FOS for GCV-resistant CMV, published results are mixed. […] The other agents that have been tried in the literature are artesunate, maribavir (MBV), and leflunomide. […] Surgery has a limited role in the management of CMV disease, but it is invaluable in severe CMV colitis with either uncontrollable hemorrhage or toxic megacolon. […] Although several studies show the utility of CMV-Ig as a prophylactic agent in transplant recipients, very few studies describe their use for the treatment of infection or disease.

• #66 Cytomegalovirus Treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4431713/

  In treating cytomegalovirus (CMV) infection, it is crucial to decide whether one is treating pre-emptively or if one is treating established disease. Disease may be further divided into viral syndrome and tissue-invasive disease. Generally, mild disease in immunosuppressed patients may be treated with oral valganciclovir. Treatment may also be started with valganciclovir for CMV retinitis in AIDS patients. In other tissue-invasive syndromes, starting with intravenous ganciclovir or foscarnet at full doses (adjusted for renal function) is preferred. Treatment at full doses should be continued until symptom resolution and until blood antigenemia (or DNAemia) is cleared. Patients receiving treatment must be closely monitored for side effects to the drugs, as well as for response. Drug-resistant CMV is a therapeutic challenge; combination therapy with both ganciclovir and foscarnet may be tried. In extreme cases, resorting to unconventional agents like leflunomide or maribavir may be necessary. Immune reconstitution, through reduction in immunosuppression, or the introduction of anti-retroviral therapy, should be attempted. CMX001 is a novel agent active against double-stranded viruses; thus far, resistance to CMX001 does not confer resistance to ganciclovir or foscarnet. Hence, prophylaxis or pre-emptive treatment with CMX001 may allow the use of ganciclovir or foscarnet for treatment.

• #67 Cytomegalovirus (CMV) | Causes, Symptoms, and Treatment

  https://patient.info/doctor/cytomegalovirus

  Patients with CMV disease should receive intravenous ganciclovir or oral valganciclovir until the resolution of symptoms and for a minimum of 14 days. Foscarnet and cidofovir are second-line therapeutic options – unless ganciclovir resistance has been demonstrated. […] If possible, a reduction in immunosuppression should be considered. […] After treatment doses have been administered, an additional 1-3 months of appropriate prophylaxis should be considered to minimise the risk of recurrent infection. […] The duration and efficacy of treatment should be determined using PCR monitoring of viral load. […] Immunocompetent patients usually require no treatment other than general advice to increase fluids and treat fever. However, patients with immunodeficiency require intensive antiviral treatment.

• #68 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/

  4 Treating CMV Infection and Disease […] For adults, children and young people who develop CMV infection or disease following solid organ transplantation: […] Offer treatment with oral Valganciclovir for a duration of at least 2 weeks [1A]. […] Adjust the dose of Valganciclovir according to licensed dosing recommendations if creatinine clearance is less than 60mL/minute [1D]. […] Be aware of the potential development of ganciclovir resistance (see section 5 for management). […] Assess CMV viral load after 2 weeks of treatment and repeat at a minimum interval of 7 days [1D] AND […] Consider stopping treatment for CMV disease after resolution of symptoms AND two consecutive, CMV viral load tests that confirm that CMV is not detected (below the local laboratory threshold for detection) [2D].

• #69

  https://link.springer.com/article/10.1007/s40506-014-0021-5

  The treatment of CMV retinitis is guided by studies in patients with AIDS. The use of i.v. GCV, i.v. FOS, p.o. VGC, and the GCV implant are all supported by randomized controlled trial (RCT) data. […] The recommended treatment of CMV-p in the HSCT recipient is i.v. GCV with immunoglobulins. […] FOS is an alternative to i.v. GCV for CMV-p. […] The optimal treatment of CMV encephalitis/myelitis is undefined. Expert reviews favor a combination of i.v. GCV and FOS. […] The first-line options for therapy of CMV disease, as mentioned above, are almost always i.v. GCV or p.o. VGC. However, in the early post-HSCT period, or in the severely neutropenic patient, one may have to start with FOS. […] Therapy of CMV disease should be started at full doses (adjusted for renal function) and continued until symptoms are clearly improved, and until antigenemia (or even DNAemia) has resolved.

• #70 Frontiers | Anti-CMV therapy, what next? A systematic review

  https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2023.1321116/full

  Human cytomegalovirus (HCMV) is one of the main causes of serious complications in immunocompromised patients and after congenital infection. There are currently drugs available to treat HCMV infection, targeting viral polymerase, whose use is complicated by toxicity and the emergence of resistance. Maribavir and letermovir are the latest antivirals to have been developed with other targets. The approval of letermovir represents an important innovation for CMV prevention in hematopoietic stem cell transplant recipients, whereas maribavir allowed improving the management of refractory or resistant infections in transplant recipients. However, in case of multidrug resistance or for the prevention and treatment of congenital CMV infection, finding new antivirals or molecules able to inhibit CMV replication with the lowest toxicity remains a critical need. This review presents a range of molecules known to be effective against HCMV. Molecules with a direct action against HCMV include brincidofovir, cyclopropavir and anti-terminase benzimidazole analogs.

• #71 Frontiers | Anti-CMV therapy, what next? A systematic review

  https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2023.1321116/full

  Immunomodulating molecules such as leflunomide and everolimus have also demonstrated indirect antiviral activity against HCMV and could be an interesting complement to antiviral therapy. The efficacy of anti-CMV immunoglobulins are discussed in CMV congenital infection and in association with direct antiviral therapy in heart transplanted patients. All molecules are described, with their mode of action against HCMV, preclinical tests, clinical studies and possible resistance. All these molecules have shown anti-HCMV potential as monotherapy or in combination with others. These new approaches could be interesting to validate in clinical trials. […] The burden of long-term therapies for immunocompromised patients, and the emergence of new resistance mechanisms, the unmet need for low toxic treatments to prevent or cure cCMV, make it essential to find new antiviral targets and to develop new therapies, in order to treat CMV infections more efficiently while reducing side effects.

• #72 Cytomegalovirus (CMV)-specific cytotoxic T lymphocyte therapy resolve CMV diseases and refractory CMV infections in paediatric recipients of allogeneic haematopoietic stem cell transplantation | Bone Marrow Transplantation

  https://www.nature.com/articles/s41409-021-01499-0

  The use of CMV-specific cytotoxic T lymphocytes (CMV-CTLs) has shown advantages in controlling refractory and late CMV infection when combined with conventional antiviral treatment in haematopoietic stem cell transplantation (HSCT) recipients. […] All patients with CMV diseases, together with another patient with refractory CMV infections, were given CMV-CTL therapy in addition to standard antiviral treatment. […] In conclusion, our results demonstrated that adoptive transfusion of donor-derived CMV-specific CTLs is effective and safe for the treatment of CMV diseases and refractory CMV infection in paediatric HSCT recipients. Early intervention with CMV-CTLs combined with standard antiviral treatment can facilitate immune recovery, resolve CMV diseases, and prevent latent CMV infection.

• #73

  https://link.springer.com/article/10.1007/s40506-014-0021-5

  The immune system is even more important. […] Given the importance of T cells in the control of CMV, a novel therapy for drug-resistant CMV disease involves the transfer of CMV-specific T cells into the patient. […] CMX001 (hexadecyloxypropyl CDV) is an orally available lipid acyclic nucleotide phosphonate that delivers high intracellular levels of CDV-diphosphate.

• #74 Frontiers | Anti-CMV therapy, what next? A systematic review

  https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2023.1321116/full

  Recently, two antiviral drugs with new targets, high specificity and low toxicity, reached clinical development: letermovir targets the highly virus-specific terminase complex and maribavir inhibits the UL97 viral kinase. Letermovir (LMV) was approved in 2017 by the Food and Drug Administration (FDA) for the prophylaxis of CMV infection in hematopoietic stem cell transplant patients with high risk of CMV infections. […] This new antiviral inhibits the terminase complex, a viral component not found in human cells, thereby reducing its toxicity. Similarly, maribavir (MBV) was approved in 2021 for the treatment of adults and children presenting post-transplant CMV infections refractory or resistant to antivirals. […] Both LMV and MBV have a high oral bioavailability and a low toxicity profile. Nevertheless, resistance mutations have already been described with these new antivirals, making it crucial to continue to develop new therapies.

• #75 Frontiers | Anti-CMV therapy, what next? A systematic review

  https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2023.1321116/full

  This is why it is necessary to find new molecules with an anti-CMV spectrum. In this context, this review summarizes the panel of molecules with antiviral activity, including direct inhibitors, molecules acting through cellular pathways inhibition and immunoglobulins. […] Letermovir (LMV; AIC246; Prevymis) acts at the late stage of the viral cycle by direct inhibition of the human CMV terminase complex. […] In 2017, LMV has been approved by the FDA for CMV prophylaxis in stem cell transplant patients seropositive for CMV. […] Maribavir (MBV; 1,263W94; LIVTENCITY) is an oral bioavailable benzimidazole riboside initially developed for treatment of refractory or resistant CMV infections. In November 2021, the FDA approved MBV for treatment of adults and children with post-transplant CMV infection/illness refractory/resistant to GCV, VGCV, CDV and FOS.

• #76 Frontiers | Anti-CMV therapy, what next? A systematic review

  https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2023.1321116/full

  Maribavir does not require activation or intracellular processing. Unlike other anti-CMV drugs, MBV targets the viral kinase UL97 and its natural substrates, which are involved in the DNA replication and viral capsid nuclear egress. […] The combination of MBV and GCV is therefore not recommended, as GCV activation requires three phosphorylation, the first of which being mediated by pUL97. […] In vitro, MBV has selective activity against CMV. Its activity has been demonstrated against Epstein–Barr virus (EBV), however it is not active against herpes simplex virus, varicella-zoster virus (VZV) or human herpesviruses 6 and 8 (HHV-6 and HHV-8). […] Preclinical studies showed that MBV has a better oral bioavailability, a better safety profile and a lower toxicity for host cells than current drugs with theoretical benefits for the viral inhibition and cross-resistances appearing.

• #77 Frontiers | Anti-CMV therapy, what next? A systematic review

  https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2023.1321116/full

  In vitro drug combination assays showed additive effect with foscarnet, and synergy with artesunate. […] Preclinical studies showed its very high antiviral activity against clinical and laboratory strains included refractory-resistant isolates to current drugs with low toxicity levels at high doses over the EC90. […] The efficacy of HCMV-HIG was proved in vitro with a higher HCMV neutralizing activity than IVIG. […] The development of infection foci was blocked by Cytotect CP with a DN50 of 0.011 to 0.033 U/mL on endothelial strains in in vitro neutralization assays. […] The effectiveness of this approach must be confirmed in clinical trials to better define the indications according to the patient profile, the history of CMV infection and the antivirals already used.

• #78 Cytomegalovirus (CMV) Medication: Antivirals, Immune Globulin, Antimetabolite

  https://emedicine.medscape.com/article/215702-medication

  The goals of pharmacotherapy are to prevent outbreaks of the disease and its complications and to reduce morbidity. Several agents are available for the treatment of cytomegalovirus (CMV) infection and disease. […] In addition, multiple agents are being looked at for the treatment of CMV disease. These include (1) CMX001 (hexadecyloxypropyl-cidofovir, an ester of cidofovir), which is under development for ganciclovir-resistant CMV disease; (2) leflunomide, a pyrimidine synthesis inhibitor (Leflunomide has been successfully used in solid organ transplant recipients for both CMV treatment and prophylaxis. Unfortunately, leflunomide failure has been reported in hematopoietic stem cell transplant recipients); and (3) artesunate, an antimalarial with some in vitro activity against CMV. […] 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.

• #79 Cytomegalovirus (CMV) infection – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cmv/symptoms-causes/syc-20355358

  Cytomegalovirus (CMV) is a common virus. Once infected, your body retains the virus for life. Most people don’t know they have cytomegalovirus (CMV) because it rarely causes problems in healthy people. […] There is no cure, but there are medications that can help treat the symptoms. […] 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.

• #80 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/

  […] […] 6 Immunosuppression dose reduction […] For adults, children and young people who develop CMV infection or disease (with or without leukopenia) following solid organ transplantation: […] Consider a dose reduction of either calcineurin inhibitor or mycophenolate mofetil / azathioprine [1C]. […] Consider preferentially reducing or stopping Mycophenolate Mofetil (MMF) or azathioprine if there is evidence of leukopenia [2C]. […] Discuss with patients, and, where appropriate, parents or carers, the risk of acute rejection with immunosuppression dose reduction [1D]. […] Review the dosing of immunosuppression following resolution of CMV infection or disease [1D]. […] […] […] 7 Information, education and support […] Offer balanced and accurate information to children, adults and young people undergoing solid organ transplantation about:

• #81 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/

  The risks of CMV infection and disease according to donor / recipient CMV serostatus and nature of immunosuppression planned or received. […] Monitoring and treatment options, including prophylaxis. […] 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 (for example, presenting information in a form suitable for developmental stage).

• #82 Clinical Overview of CMV and Congenital CMV | Cytomegalovirus (CMV) and Congenital CMV Infection | CDC

  https://www.cdc.gov/cytomegalovirus/hcp/clinical-overview/index.html

  No treatment is currently indicated for CMV infection in healthy people. Antiviral treatment is used for people with compromised immune systems who have either sight-related or life-threatening illnesses due to CMV infection. […] Antiviral medications such as ganciclovir or valganciclovir may improve hearing and developmental outcomes in newborns with signs of congenital CMV. Ganciclovir can have serious side effects and has only been studied in infants with symptomatic congenital CMV disease. There is limited information on the effectiveness of ganciclovir or valganciclovir to treat infants with hearing loss alone. […] Any newborn diagnosed with congenital CMV infection should have regular hearing and vision tests. Most infants with congenital CMV grow up healthy. Some babies may have hearing loss that may or may not be detected by newborn hearing test. Hearing loss can be present at birth or develop later and may progress with age.

• #83 Clinical Overview of CMV and Congenital CMV | Cytomegalovirus (CMV) and Congenital CMV Infection | CDC

  https://www.cdc.gov/cytomegalovirus/hcp/clinical-overview/index.html

  As a healthcare provider, you play an important role in helping parents understand the services a child with congenital CMV infection may need. This can include getting hearing aids, regular hearing and vision screenings, and speech, occupational, and physical therapy. […] Early detection and intervention for children with hearing and vision problems may improve outcomes and help strengthen their communication and language skills, leading to positive social interactions and educational development.

• #84 Cytomegalovirus (CMV) Infection – Infections – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/infections/herpesvirus-infections/cytomegalovirus-cmv-infection

  Mild cytomegalovirus infection is usually not treated. It subsides on its own. […] When the infection threatens life or eyesight, an antiviral medication (valganciclovir, ganciclovir, cidofovir, foscarnet, maribavir, or a combination) may be given. These antivirals may be given by mouth or by vein. When CMV retinitis is very severe, the medications may also be injected directly into the eye. These medications have serious side effects and do not cure the infection. However, treatment slows the disease’s progression and may preserve sight. […] Antivirals are used to treat other severe symptoms due to CMV but are less reliably effective than when used to treat retinitis. […] If CMV infection occurs in people whose immune system is temporarily weakened or suppressed (by a disorder or medication), the infection usually subsides when the immune system recovers or the medication is stopped. […] Treating people who have HIV/AIDS with medications used to control HIV (antiretroviral medications) helps protect against CMV infection. […] People who have had an organ transplant are often given antivirals (such as ganciclovir, valganciclovir, or foscarnet) to prevent CMV infection.

• #85 Cytomegalovirus (CMV) infection – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cmv/symptoms-causes/syc-20355358

  Cytomegalovirus (CMV) is a common virus. Once infected, your body retains the virus for life. Most people don’t know they have cytomegalovirus (CMV) because it rarely causes problems in healthy people. […] There is no cure, but there are medications that can help treat the symptoms. […] 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.

Zobacz więcej