Adenovirus Treatment & Management

Updated: May 18, 2017
  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Medical Care

Currently, specific therapy for adenovirus infection, other than supportive and symptomatic treatment, remains a matter of debate. Fortunately, most infections are self-limited in the setting of a normal immune response and do not warrant specific therapy.

Several drugs, such as cidofovir, ribavirin, ganciclovir, and vidarabine, have been used to treat adenovirus infections, especially in immunocompromised patients. Most of these agents are virostatic and have significant risks of adverse events, including some risks to healthcare staff depending on mode of delivery (eg, aerosolized ribavirin). The management and prevention of severe adenovirus-related disease, especially in hematologic stem cell transplantation, continues to evolve.

No evidence-based guidelines for or against specific antiviral therapies in this setting are available, and treatment decisions should be individualized and based on most recently published literature on advances in hematologic malignancy.

Attempts to shed light on this issue have included retrospective reviews of adenoviral disease in bone marrow transplant recipients. Some benefit of both ribavirin and cidofovir has been documented in case series, as demonstrated by decreased viremia and concomitant clinical improvement with antiviral therapy. [23, 24, 25, 26] Cidofovir treatment resulted in complete clinical resolution in 56 of 57 pediatric hematopoietic stem cell recipients, in whom the virus became undetectable without dose-limited nephrotoxicity. [27]

T-cell–depleted grafts and severe lymphopenia are a major risk factor for adenoviral disease in children post hematologic stem cell transplantation, and some centers have established successful prophylaxis protocols with cidofovir, as well as adoptive transfer of donor-derived, virus-specific T cells. [28]

Intravenous immunoglobulin (IVIG) has also been used in conjunction with antivirals. [29]

Engraftment or recovery of T-cell–specific immunity has been suggested as vital to recovery from pulmonary or disseminated infection, regardless of antiviral therapy. [30] In one study involving children who underwent hematopoietic stem cell transplantation, all patients who died of adenoviral infection lacked specific T cells against adenovirus. [30]



Consultation with an ophthalmologist should be sought in the follow-up care of persons with keratoconjunctivitis, preferably early, but particularly if they develop corneal opacities.

If hemorrhagic cystitis does not resolve within 5 days, consider noninfectious etiologies and consultation with a urologist or nephrologist, as appropriate.

Immunosuppressed patients may present with various adenoviral syndromes, ranging from afebrile hemorrhagic cystitis to fulminant disseminated disease (followed by shock and death). Consultation with an infectious disease specialist is helpful in this setting.



After a 12-year hiatus, the FDA approved a live oral vaccine against adenovirus types 4 and 7 in 2011. It is indicated for use only by the US Department of Defense for military recruits entering basic training. No commercial vaccine is currently approved for public use.