From the Guidelines
Treatment of adenovirus infections is primarily supportive, focusing on relieving symptoms while the immune system fights the infection, as there is no proven effective treatment for eradication of adenovirus infection. According to the most recent study on conjunctivitis preferred practice pattern published in 2024 in the journal Ophthalmology 1, the majority of cases of acute, infectious conjunctivitis in the adult population are viral and self-limited, and do not require antimicrobial treatment.
Key Considerations
- Patients with adenoviral conjunctivitis should be educated about measures to reduce the spread of the infection, such as minimizing contact with other people for 10 to 14 days from the onset of symptoms in the last eye affected 1.
- To minimize spread within the clinic, an abbreviated exam in a dedicated exam room with limited physical interaction should be considered 1.
- Artificial tears, topical antihistamines, topical steroids, oral analgesics, or cold compresses may be used to mitigate symptoms, but the use of antibiotics should be avoided due to potential adverse treatment effects 1.
- Topical corticosteroids may be helpful to reduce symptoms and scarring in severe cases, but close follow-up is warranted due to the potential for prolonged viral shedding 1.
Management
- For adenoviral conjunctivitis, artificial tears and cold compresses can provide relief, while avoiding touching the eyes and practicing good hand hygiene helps prevent spread.
- In severe cases, particularly in immunocompromised patients, hospitalization with supportive care may be necessary.
- The antiviral cidofovir may be considered in severe cases, but it carries significant renal toxicity and should be administered with probenecid to reduce kidney damage, although this is not specifically recommended for adenoviral conjunctivitis in the provided study 1.
From the Research
Treatment Options for Adenovirus Infections
- The treatment of severe adenovirus keratoconjunctivitis and life-threatening adenovirus infections in immunocompromised patients is still unsatisfactory 2.
- Several nucleoside or nucleotide analogues have been described that target the adenovirus polymerase, whereas other antiviral targets have been poorly investigated 2.
- Optimal therapeutic response may be achieved by combining antiviral therapy with immunotherapeutic approaches, as currently being explored 2.
Antiviral Therapies
- Currently, no approved antiviral therapies specific to human adenovirus (HAdV) exist 3.
- Recent developments in search of potential therapeutic agents for controlling HAdV infections include those targeting post-entry stages of the virus replicative cycle 3.
- The currently available antiviral agents, ribavirin and cidofovir, have yielded mixed results in case reports and small case series 4.
Emerging Therapeutics
- Brincidofovir (CMX001) is a lipid conjugate of cidofovir, with good oral bioavailability, no associated nephrotoxicity, and higher intracellular levels of the active drug compared to cidofovir 5.
- Brincidofovir (CMX001) along with other supportive therapy, may offer an efficacious, safe, and well-tolerated treatment for severe adenoviral infections in solid organ transplant recipients 5.
- New strategies, including pre-emptive therapy, should be tested in prospective, clinical trials 4.
- New agents and adoptive transfer of specific T-cells to adenovirus might improve the current situation 4.
Clinical Features and Treatment
- Adenoviruses (Ads) are common opportunistic pathogens that are rarely associated with severe clinical symptoms in healthy individuals 6.
- In patients with compromised immunity, Ad infections often result in disseminated and potentially life-threatening disease 6.
- There is currently no formally approved antiviral therapy for the treatment of severe Ad keratoconjunctivitis and life-threatening Ad infections in immunocompromised patients 6.