title: An artesunate-containing antimalarial treatment regimen did not suppress cytomegalovirus viremia.
abstract: BACKGROUND
  Additional drugs are needed for the treatment of cytomegalovirus (CMV) infection. Artesunate is an antimalarial drug that has activity against CMV in vitro and in a rodent model. Only a small number of case reports are available describing the clinical effects of artesunate on CMV infection, and these yielded inconsistent results.
  
  
  OBJECTIVE
  To evaluate the effect of artesunate on CMV infection, using blood samples collected from children who participated in malaria treatment trials.
  
  
  METHODS
  Quantitative CMV DNA PCR was performed on dried blood spots collected from 494 Ugandan children, who were randomized either to artesunate plus amodiaquine or sulfadoxine-pyrimethamine plus amodiaquine for acute malaria infection. Poisson regression was used to compare treatment regimens with respect to the change in the frequency and quantity of CMV detected that occurred before and after treatment.
  
  
  RESULTS
  CMV was detected in 11.4% of children immediately prior to treatment and 10.7% 3 days later (p=0.70). The average quantity of CMV was 0.30 log10 copies per million cells higher on day 3 than at treatment initiation (95% CI 0.01-0.58, p=0.041). There was no measurable difference in either the frequency or quantity of CMV detected in blood between children randomized to the two treatment arms.
  
  
  CONCLUSIONS
  A standard 3-day artesunate-containing antimalarial regimen had no detectable effect on CMV viremia in children with malaria. Longer treatment courses and/or higher doses of artesunate than those routinely used for malaria may be required for effective treatment of CMV infection.
authors.affiliation: Seattle Children's Hospital, Seattle, WA, USA. sgantt@cw.bc.ca
authors.forename: Soren
authors.initials: S
authors.lastname: Gantt
authors.forename: Meei-Li
authors.initials: ML
authors.lastname: Huang
authors.forename: Amalia
authors.initials: A
authors.lastname: Magaret
authors.forename: Lisa
authors.initials: L
authors.lastname: Bunts
authors.forename: Stacy
authors.initials: S
authors.lastname: Selke
authors.forename: Anna
authors.initials: A
authors.lastname: Wald
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Rosenthal
authors.forename: Grant
authors.initials: G
authors.lastname: Dorsey
authors.forename: Corey
authors.initials: C
authors.lastname: Casper
mesh_terms: D000293:Adolescent; D000962:Antimalarials / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use*; D000077332:Artesunate; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000188:drug therapy*; D004279:DNA, Viral / Q000097:blood; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D008288:Malaria / Q000150:complications / Q000188:drug therapy; D008297:Male; D060888:Real-Time Polymerase Chain Reaction; D016896:Treatment Outcome; D014454:Uganda; D014766:Viremia / Q000188:drug therapy*
chemical_list: D000962:Antimalarials; D000998:Antiviral Agents; D037621:Artemisinins; D004279:DNA, Viral; D000077332:Artesunate
keywords: Antiviral; Artesunate; CMV; Cytomegalovirus; DBS; Malaria; Treatment; cytomegalovirus; dried blood spot