Parameters for the Successful Management of Cytomegalovirus

Abstract

Cytomegalovirus (CMV) is a major pathogen for the neonate and the transplant recipient in both of whom the incidence of the disease and its severity are increased when the donor, or mother, has a primary infection. Many individuals with recurrent infection who experience the disease do so because they are being reinfected from an exogenous source, rather than reactivating their own strain, arguing that natural immunity can reduce, but not completely control, CMV disease. Antiviral therapy is thus needed to control CMV disease. There are four major strategies for the use of drugs against CMV - prophylaxis, suppression, pre-emptive therapy and treatment; significant benefit has been shown for some of these in some groups of transplant patients. The strategies must now be compared, and patient management regimes comparing the various approaches should be considered.