Cytomegalic virus treatment

If you're healthy, CMV mainly stays dormant. When the virus is active in your body, you can pass the virus to other people. The virus is spread through body fluids — including blood, urine, saliva, breast milk, tears, semen and vaginal fluids.

Casual contact doesn't transmit CMV. CMV is a widespread and common virus that can infect almost anyone. Complications of CMV infection vary, depending on your overall health and when you were infected. Rarely, CMV causes a healthy adult to develop mononucleosis. Other rare complications for healthy adults include problems with the digestive system, liver, brain and nervous system.

An infant whose mother first became infected with CMV during pregnancy is more likely to experience complications. Complications for the baby can include:. Careful hygiene is the best prevention against CMV.

You can take these precautions:. 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. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.

Nine cleared viremia only to relapse. In five cases, viremia was not suppressed and the patients went on to develop end-organ disease, e. Mylonakis et al. The author has had success using the combination. The situation becomes difficult when the patient does not respond to a combination of GCV and FOS, and when sequencing reveals mutations conferring high-level resistance to both agents.

In this life-threatening circumstance, resorting to novel agents seems justified. Further, a discussion with the transplant physician about reducing immunosuppression, or switching immunosuppression to sirolimus, is indicated. Sirolimus, considering that it is an immunosuppressant, is fascinating. Based on observations that CMV infections were relatively infrequent in sirolimus-treated patients [ 60 ], Ozaki et al.

Eight of their nine patients cleared antigenemia. The other agents that have been tried in the literature are artesunate, maribavir MBV , and leflunomide. The first report of the successful use of artesunate for the treatment of drug-resistant CMV was in a year-old HSCT recipient [ 63 ]. Artesunate resulted in a 1.

Lau et al. In fact, artesunate has broad activity against the herpes viruses. Avery et al. Five of them cleared viremia, though one died of multi-organ failure. The sixth patient continued to have low-grade viremia but her retinitis stabilized and she experienced no further CMV-related symptoms. The median duration of treatment was days, and no patient had renal, hepatic, or hematologic toxicity.

Leflunomide is an immunosuppressive agent, approved for rheumatoid arthritis, that appears to inhibit virion assembly rather than DNA synthesis [ 69 ]. Indian investigators used it as primary therapy in four renal transplant recipients who could not afford the conventional anti-CMV agents [ 70 ]. Levi et al. The authors also measured levels of leflunomide in serum and vitreous, and response was demonstrated only when doses were raised.

Intravitreal fomivirsen was also used, which means that leflunomide was not used as the sole therapeutic agent. 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.

Colectomy sub-total or total may be life-saving [ 72 — 74 ]. 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 [ 75 ]. Lautenschlager et al. Success, as defined by defervescence, improvement in the general condition of the patient, and normalization of white cell and platelet counts, was noted in 23 of 24 cases.

Other authors have used CMV-Ig in pre-emptive fashion in hypogammaglobulinemic heart transplant patients, with a reduction in the incidence of opportunistic infection including CMV. In the studies of Yamani et al. In a separate analysis, the same authors found 56 heart transplant patients with moderate hypogammaglobulinemia and randomized them to two arms — CytoGam or placebo [ 78 ].

CMV infection was statistically less common in the CytoGam arm. These are not really treatment studies, as the patients were started on CMV-Ig based not on antigenemia or DNAemia, but on a low globulin level.

In only one condition CMV pneumonitis is it thought to be an essential part of the therapy vide supra , though none of the historically important studies leading to this practice was a randomized comparison.

Although drugs are important in the control of CMV infection, the immune system is even more important. Using cytokine flow cytometry to detect CMV-specific responses, Radha et al. But a sero-negative patient without T-cell responses took a long time to clear CMV DNA even though immunosuppression was reduced and full-dose p.

VGC was used. Manuel et al. Those with a positive response were less likely to develop CMV disease than those with a negative or indeterminate result.

Hence, in the management of CMV infection and disease, consideration should always be given for the reduction of immunosuppression. The technical details are beyond the scope of this paper; several techniques to generate virus-specific T cells have been described. Walter et al. Mackinnon et al. Similarly, Cobbold et al. Evidence of CMV-specific T-cell immunity was demonstrated in all nine patients after the adoptive transfer.

CMV reactivation resolved completely in eight patients [ 83 ]. Einsele et al. Antiviral therapy was stopped on the day of infusion. CMV DNA became undetectable between 5 and 31 days after the infusion, which was not associated with toxicity [ 84 ]. The same group has also used ppselected T cells to treat chemorefractory CMV disease, with a high success rate [ 85 ]. However, in these reports, the cells that were to be infused had to be specially prepared for each patient who required the therapy.

Further, cells had to be obtained from the original donor. However, in the Feuchtinger et al. The banking of virus-specific cell lines would simplify the process — and indeed has been successfully attempted. Leen et al. Patients who had received T-cell immunosuppressive monoclonal antibodies in the previous month were excluded, as were those with grade II—IV graft versus host disease.

Early human studies showed no significant effects on blood chemistries or hematology [ 87 ]. Diarrhoea was the main side effect [ 88 ]. This study also established the dose of mg twice weekly as the best tolerated dose, with adequate suppression of CMV. A variety of doses were used, so the optimal dose has yet to be ascertained. Much progress has been made against CMV in transplantation. Data on the treatment of CMV in other categories of immunosuppressed individuals e.

Studies that define the role of newer agents like MBV and CMX , and work that will make adoptive immunotherapy more accessible should improve patient outcomes. This article does not contain any studies with human or animal subjects performed by any of the authors.

National Center for Biotechnology Information , U. Current Treatment Options in Infectious Diseases. Curr Treat Options Infect Dis. Published online Jun Author information Copyright and License information Disclaimer. Corresponding author. Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author s and the source are credited.

This article has been cited by other articles in PMC. Opinion statement In treating cytomegalovirus CMV infection, it is crucial to decide whether one is treating pre-emptively or if one is treating established disease. Keywords: cytomegalovirus, pre-emptive therapy, retinitis, encephalitis, pneumonitis, ganciclovir, valganciclovir, foscarnet, cidofovir, drug resistance, maribavir, adoptive immunotherapy, CMX Introduction Cytomegalovirus CMV infection is a common complication of immunosuppression, and is frequently seen in transplant recipients, patients with the acquired immunodeficiency syndrome AIDS , and those who have received steroids [ 1 ].

Treatment When there were no anti-viral medications effective against CMV, the only option physicians had was reduction of immunosuppression [ 2 ]. Pharmacologic treatment The standard drugs The first-line options for therapy of CMV disease, as mentioned above, are almost always i. Oral valganciclovir The earliest large study that demonstrated non-inferiority of p.

Table 1 When should CMV drug resistance be considered? Open in a separate window. Leflunomide Leflunomide is an immunosuppressive agent, approved for rheumatoid arthritis, that appears to inhibit virion assembly rather than DNA synthesis [ 69 ]. Surgery 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.

Other treatments The role of CMV-Ig 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 [ 75 ]. Emerging therapies The importance of the immune system Although drugs are important in the control of CMV infection, the immune system is even more important.

Summary Much progress has been made against CMV in transplantation. Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading. Rubin RH. Infection in organ transplant recipients. Clinical approach to infection in the compromised host. New York: Plenum; Cytomegalovirus infection. Oxford textbook of medicine. Oxford: Oxford University Press; Updated international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation.

Related Information. March of Dimes. See all related organizations. Clinical Trials. Patient Organizations. Department of Health and Human Services.

Atlanta, GA Tel: ; ; Arlington, VA Bethesda, MD Tel: 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.