title: Cytomegalovirus.
abstract: OBJECTIVE
  To consider new treatment options for cytomegalovirus (CMV) infection, review recent trials, and anticipate their use in clinical practice, focussing on bone marrow transplantation, congenital infection, and intervention during pregnancy.
  
  
  RESULTS
  Three double-blind randomized placebo-controlled phase 2 proof-of-concept studies have each identified a novel antiviral drug with activity against CMV infection in bone marrow transplant patients. One of these (brincidofovir) inhibits the DNA polymerase that is the target of the currently licensed drug ganciclovir. Another new drug (maribavir) inhibits a protein kinase which, coincidentally, is the enzyme responsible for activating ganciclovir through phosphorylation. The third drug (letermovir) inhibits the terminase enzyme complex responsible for packaging unit length DNA into assembling virions.In addition, in a double-blind randomized placebo-controlled trial in neonates with symptomatic congenital CMV infection, a 6-month course of valganciclovir was superior to the standard 6-week course of the same drug. In pregnant women with primary CMV infection, administration of hyperimmune immunoglobulin did not significantly reduce transmission of CMV across the placenta.
  
  
  CONCLUSIONS
  The ability to diagnose CMV infections reliably in different clinical settings through application of molecular laboratory methods has ushered in new ways of evaluating potential new treatments for CMV. Several of these may help control the diseases caused by this important human pathogen.
authors.affiliation: Centre for Virology, UCL Medical School, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Griffiths
authors.forename: Sheila
authors.initials: S
authors.lastname: Lumley
mesh_terms: D000085:Acetates / Q000008:administration & dosage; D000998:Antiviral Agents / Q000008:administration & dosage*; D001562:Benzimidazoles / Q000008:administration & dosage; D016026:Bone Marrow Transplantation; D003587:Cytomegalovirus / Q000187:drug effects* / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000151:congenital / Q000188:drug therapy* / Q000276:immunology; D003596:Cytosine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage; D006801:Humans; D008297:Male; D016377:Organ Transplantation; D063065:Organophosphonates / Q000008:administration & dosage; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D011799:Quinazolines / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D012263:Ribonucleosides / Q000008:administration & dosage; D004004:Dichlororibofuranosylbenzimidazole / Q000031:analogs & derivatives
chemical_list: D000085:Acetates; D000998:Antiviral Agents; D001562:Benzimidazoles; D003596:Cytosine; D015774:Ganciclovir; D063065:Organophosphonates; D011799:Quinazolines; D012263:Ribonucleosides; C000588473:letermovir; C525733:brincidofovir; C400401:maribavir; D004004:Dichlororibofuranosylbenzimidazole