From the Guidelines
Adenovirus infections in immunocompromised patients should be managed with a multifaceted approach, prioritizing reduction of immunosuppression when possible and implementation of infection control measures, including contact precautions and proper hand hygiene, as recommended by guidelines such as those from the CDC and the Healthcare Infection Control Practices Advisory Committee 1.
Key Considerations
- Reducing immunosuppression allows the patient's immune system to better combat the infection.
- For severe infections, antiviral medications such as cidofovir may be considered, although the most recent and highest quality evidence does not specifically support its use in this context over other options.
- Supportive care, including maintaining fluid balance, respiratory support if needed, and managing specific organ involvement, is crucial.
- Regular monitoring of renal function, electrolytes, and complete blood counts is necessary during treatment due to potential medication toxicity.
- Infection control measures are critical to prevent transmission, and nucleic acid-based testing for noninfluenza viral pathogens, including adenovirus, should be considered in immunocompromised patients at high risk for death from respiratory viral infection, as suggested by the American Thoracic Society 1.
Infection Control and Prevention
- Contact precautions and proper hand hygiene are essential to minimize the risk of transmission to other patients and contamination of environmental surfaces or equipment.
- Minimizing patient dispersal of droplets by having the patient wear a surgical mask is also recommended.
Treatment Approach
- The approach to treatment should be individualized based on the severity of the infection, the patient's immune status, and the potential risks and benefits of antiviral therapy.
- The use of cidofovir or other antiviral medications should be guided by the most recent and highest quality evidence, and considered in the context of the patient's overall clinical condition and potential for benefit 1.
From the FDA Drug Label
TEMBEXA efficacy may be reduced in immunocompromised patients based on studies in immune deficient animals. (1.2)
The drug label does not provide information on the treatment of adenovirus in immunocompromised patients. Brincidofovir (TEMBEXA) is indicated for the treatment of human smallpox disease, and its efficacy in treating other diseases, including adenovirus, is not established. Key points:
- The label mentions reduced efficacy in immunocompromised patients, but this is in the context of smallpox disease, not adenovirus.
- There is no direct information on the use of brincidofovir for adenovirus in immunocompromised patients 2.
From the Research
Adenovirus Infection in Immunocompromised Patients
- Adenovirus infection contributes to significant morbidity and mortality in immunocompromised patients, especially after allogeneic hematopoietic cell transplantation (HCT) 3.
- Brincidofovir (BCV) has shown antiviral activity against adenoviruses and may be used as a pre-emptive treatment for asymptomatic adenovirus viremia in pediatric and adult allogeneic HCT recipients 3.
- Cidofovir (CDV) is another antiviral compound that has been used to treat adenovirus infections in immunocompromised patients, despite concerns of potential nephrotoxicity 4, 5.
Treatment Options
- Brincidofovir (BCV) has been shown to be effective in reducing adenovirus viremia and preventing adenovirus disease in immunocompromised patients 3, 6.
- Cidofovir (CDV) has also been used to treat adenovirus infections in immunocompromised patients, with some studies suggesting it is safe and reasonably tolerated in pediatric populations 4, 7, 5.
- The choice of treatment may depend on the severity of the infection, the patient's renal function, and the presence of other comorbidities 3, 6.
Safety and Efficacy
- Brincidofovir (BCV) has been shown to be well-tolerated in immunocompromised patients, with minimal adverse effects 3, 6.
- Cidofovir (CDV) has been associated with nephrotoxicity, but some studies suggest that this risk may be lower in immunocompetent children 7.
- Further studies are needed to fully evaluate the safety and efficacy of these treatments in immunocompromised patients 3, 4, 5, 6.