title: Prophylaxis and treatment of respiratory syncytial virus in adult immunocompromised patients.
abstract: OBJECTIVE
  To review the literature regarding current strategies and strategies under active development for the prevention and treatment of respiratory syncytial virus (RSV) infections in immunocompromised adults.
  
  
  METHODS
  The MEDLINE/PubMed, EMBASE, and Cochrane databases were queried from January 1980 to December 2011 for articles in English using these associated search terms: respiratory syncytial virus, ribavirin, intravenous immunoglobulin, IVIG, palivizumab, motavizumab, lung, pneumonia, transplantation, bone marrow, cancer, malignancy, and vaccine.
  
  
  METHODS
  All relevant original studies, meta-analyses, systematic reviews, and review articles were assessed for inclusion. References from pertinent articles were examined for additional content not found during the initial search.
  
  
  RESULTS
  RSV in the immunocompromised adult can lead to significant morbidity and mortality. Treatment of RSV-infected adults is limited to antiviral therapy with ribavirin (aerosolized, oral, intravenous) and immunomodulation with intravenous immunoglobulins, corticosteroids, and palivizumab. Existing literature is predominantly case reports, small trials, and retrospective reviews of patients infected with RSV who have undergone lung or hematopoietic stem cell transplantation (HSCT). Palivizumab may be a viable option for prophylaxis against RSV in high-risk adults. Ribavirin is the most studied treatment option and should remain the backbone of multidrug regimens. Of the routes of administration, aerosolized ribavirin carries the preponderance of evidence and, though challenging, is preferred to limit systemic toxicities in the infected patient. Addition of an immunomodulator to ribavirin may provide a survival benefit over ribavirin alone; however, this has only been studied in a subset of HSCT patients with lower respiratory tract RSV infection.
  
  
  CONCLUSIONS
  Research most strongly supports the use of aerosolized ribavirin as the treatment strategy for immunocompromised adults with RSV. Addition of an immunomodulator may provide a survival benefit over ribavirin alone. Strategies and supportive data for the prevention of RSV infection in the high-risk adult are critically needed.
authors.affiliation: School of Pharmacy, University of Maryland, Baltimore, MD, USA. lhynicka@rx.umaryland.edu
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Hynicka
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Ensor
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D016867:Immunocompromised Host; D007155:Immunologic Factors / Q000008:administration & dosage / Q000627:therapeutic use*; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy* / Q000517:prevention & control / Q000821:virology; D012254:Ribavirin / Q000008:administration & dosage / Q000627:therapeutic use; D012307:Risk Factors
chemical_list: D000998:Antiviral Agents; D007155:Immunologic Factors; D012254:Ribavirin