From the Guidelines
Cytomegalovirus (CMV) is a common and usually harmless herpesvirus that can cause serious disease in people with weakened immune systems, such as transplant recipients, HIV/AIDS patients, and newborns infected during pregnancy. It belongs to the Herpesviridae family and, once contracted, remains dormant in the body for life 1. For most healthy individuals, CMV infection causes no symptoms or only mild illness resembling mononucleosis with fever, fatigue, and swollen glands. However, CMV can cause serious disease in immunocompromised individuals, and congenital CMV infection can lead to hearing loss, vision problems, and developmental delays in infants.
Key Characteristics of CMV
- CMV is a double-stranded DNA virus that can cause disseminated or localized end-organ disease among patients with advanced immunosuppression 1
- Most clinical disease occurs in previously infected (seropositive) persons and so represents either reactivation of latent infection or reinfection with a novel strain 1
- The virus spreads through bodily fluids including saliva, urine, blood, tears, semen, and breast milk
- Prevention measures include good hygiene practices like handwashing
Diagnosis and Treatment
- In immunocompetent individuals suspected of having acute CMV infection, testing for CMV-specific antibodies is recommended as the first line laboratory diagnostic test 1
- Antiviral medications such as ganciclovir, valganciclovir, foscarnet, or cidofovir are used to treat severe cases of CMV infection 1
- These medications don't eliminate the virus but help control its replication and reduce symptoms
- Regular monitoring is important for immunocompromised individuals who are at higher risk for CMV reactivation 1
Special Considerations
- Organ donors and recipients should be tested for prior (latent) CMV infection by EIA to establish risk assessment and definition of an appropriate surveillance and/or antiviral prophylaxis to be instituted after transplantation 1
- In recipients of organ or peripheral blood stem cell transplants, CMV viral load by NAAT or antigenemia is used as a marker for preemptive therapy, to diagnose CMV-associated signs and symptoms, and to monitor response to antiviral therapy 1
From the Research
What is Cytomegalovirus (CMV)
- Cytomegalovirus (CMV) is a herpes virus that can cause severe illness and death in people with weakened immune systems, including organ and bone marrow transplant recipients, HIV-infected individuals, and newborns infected during pregnancy 2.
- CMV is a common infection in the community, but diagnosis can be challenging, and it often requires careful clinical assessment and diagnostic tests 2.
Who is at Risk
- Immunocompromised hosts, such as those with HIV/AIDS, organ transplant recipients, and patients on immunosuppressive drugs, are at increased risk of CMV infection and disease 3, 4.
- Newborns infected with CMV during pregnancy are also at risk of developing serious CMV disease 2.
Treatment and Prevention
- Antiviral agents, such as ganciclovir, valganciclovir, foscarnet, and cidofovir, are available for the treatment and prevention of CMV infection and disease 3, 4, 5.
- Valganciclovir, an oral prodrug of ganciclovir, has been shown to be effective in preventing CMV infection and disease in high-risk solid organ transplant recipients and has a more convenient once-daily dosing regimen compared to intravenous ganciclovir 4, 5.
- However, valganciclovir has been associated with a higher risk of absolute neutropenia and late-onset CMV disease compared to other therapies, and its use as a first-line agent for CMV prevention in solid organ transplant patients has been questioned 6.
Key Points
- CMV is a common and potentially serious infection in immunocompromised individuals.
- Diagnosis and treatment of CMV require careful clinical assessment and antiviral therapy.
- Valganciclovir is an effective antiviral agent, but its use should be carefully considered due to potential risks and side effects 6.