Immunocompromised hosts: perspectives in the treatment and prophylaxis of cytomegalovirus disease in solid-organ transplant recipients.
Cytomegalovirus (CMV) infection is an important complication of solid-organ transplantation. The availability of potent antiviral therapies has decreased the incidence of CMV disease among solid-organ transplant recipients but has also led to challenges, including ganciclovir resistance, late-onset CMV disease, and uncertainty about the optimal duration of prophylaxis or therapy for CMV disease. Specific therapies and management of CMV resistance will be addressed here. The best approach for CMV disease in solid-organ transplant recipients is prevention, but which strategy--prophylaxis or preemptive therapy--is optimal remains debatable. Ganciclovir and valganciclovir remain the best options for prevention and treatment of CMV disease in solid-organ transplant recipients, but they are costly and associated with toxicity. Foscarnet and cidofovir, indicated for the treatment of patients who fail to respond to ganciclovir, are less attractive alternatives because of renal toxicity. Therefore, new therapeutic agents for CMV and an immunogenic, safe CMV vaccine are critically needed.
Torres-Madriz
Gilberto
G
Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center and Tufts University Medical School, Boston, Massachusetts 02111, USA. gtorres1@tuftsmedicalcenter.org
Boucher
Helen W
HW
D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D018890:Chemoprevention / Q000379:methods*; D000077404:Cidofovir; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000517:prevention & control*; D003596:Cytosine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D024882:Drug Resistance, Viral; D017245:Foscarnet / Q000009:adverse effects / Q000627:therapeutic use; D015774:Ganciclovir / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D016867:Immunocompromised Host; D016377:Organ Transplantation / Q000009:adverse effects*; D063065:Organophosphonates / Q000009:adverse effects / Q000627:therapeutic use; D014180:Transplantation; D000077562:Valganciclovir
D000998:Antiviral Agents; D063065:Organophosphonates; D017245:Foscarnet; D003596:Cytosine; D000077562:Valganciclovir; D000077404:Cidofovir; D015774:Ganciclovir