Cytomegalovirus Medication: Antivirals, Immune Globulin, Antimetabolite

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Medication

Medication Summary

The goals of pharmacotherapy are to prevent outbreaks of the disease and its complications and to reduce morbidity. Several agents are currently available for the treatment of cytomegalovirus (CMV) infection and disease.

In addition, multiple agents are being looked at for the treatment of CMV disease. These include (1) CMX001 (hexadecyloxypropyl-cidofovir, an ester of cidofovir), which is under development for ganciclovir-resistant CMV disease^[78]; (2) leflunomide, a pyrimidine synthesis inhibitor^[79](Leflunomide has been successfully used in solid organ transplant recipients for both CMV treatment and prophylaxis. Unfortunately, leflunomide failure has been reported in hematopoietic stem cell transplant recipients.^[76]); and (3) artesunate, an antimalarial with some in vitro activity against CMV.^{[80, 81]}

Another experimental agent, letermovir (AIC246), a member of the novel class of 3,4-dihydroquinazolinyl acetic acids, was administered to a lung transplant recipient with multidrug-resistant disseminated CMV infection (viremia, pneumonitis, colitis, retinitis) in combination with reduced immunosuppression.^[82]The patient experienced rapid clinical, virologic, and radiographic resolution of disease.

Maribavir, a benzimidazole antiviral agent, has been used as salvage therapy in a small number of patients with multidrug-resistant CMV,^[70]but was unsuccessful when used as CMV prophylaxis in allogeneic stem cell transplant patients^[71]or in liver transplant recipients.

Class Summary

CMV is a double-stranded DNA virus. Drugs currently used for the treatment of DNA viral infections affect the viral DNA polymerase and affect viral DNA replication.

Ganciclovir (Cytovene)

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Ganciclovir is a synthetic guanine derivative nucleoside analog active against CMV. It inhibits replication of herpes viruses both in vitro and in vivo. In patients with HIV infection, resistance manifests as progressive disease.

Foscarnet (Foscavir)

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Foscarnet inhibits viral replication of herpesviruses (CMV, HSV-1, HSV-2) at pyrophosphate-binding site on virus-specific DNA polymerases. It is used for ganciclovir-resistant CMV retinitis and herpes simplex disease.

Cidofovir (Vistide)

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Cidofovir is approved for the treatment of CMV retinitis in AIDS. It is a nucleotide analog, whose active metabolite inhibits herpes virus polymerases at concentrations that are 8- to 600-fold lower than those needed to inhibit human cellular DNA polymerases alpha, beta, and gamma. Incorporation of cidofovir into the growing viral DNA chain results in reductions in the rate of viral DNA synthesis.

Valganciclovir (Valcyte)

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Valganciclovir is an L-valyl ester prodrug of ganciclovir. It is used for CMV disease prophylaxis in various solid organ transplant recipients. It inhibits the replication of human CMV in vitro and in vivo. Valganciclovir achieves serum levels comparable to those obtained with IV ganciclovir.

Class Summary

Consists of administration of immunoglobulin pooled from serum of immunized subjects.

Cytomegalovirus immune globulin (CMV IG)

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CMV immune globulin (CMV-IG) is a preparation of immunoglobulin derived from pooled healthy blood donors with high CMV titers; administration provides a passive source of antibodies against cytomegalovirus. It is used for CMV pneumonia treatment. It may also be used for CMV prophylaxis in heart, lung, kidney, liver and pancreas transplant recipients, in addition to ganciclovir.

Class Summary

These agents inhibit cell growth and proliferation.

Leflunomide (Arava)

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Leflunomide has been used off-label in the treatment of cytomegalovirus (CMV) disease in transplant recipients, as well as in the prevention of acute and chronic rejection in recipients of solid organ transplants. It inhibits pyrimidine synthesis (via dihydroorotate dehydrogenase inhibition), leading to immunomodulatory and antiproliferative activity.

Follow-up

Zhang LJ, Hanff P, Rutherford C, Churchill WH, Crumpacker CS. Detection of human cytomegalovirus DNA, RNA, and antibody in normal donor blood. J Infect Dis. 1995 Apr. 171(4):1002-6. [Medline].
Collier AC, Meyers JD, Corey L, Murphy VL, Roberts PL, Handsfield HH. Cytomegalovirus infection in homosexual men. Relationship to sexual practices, antibody to human immunodeficiency virus, and cell-mediated immunity. Am J Med. 1987 Mar 23. 82(3 Spec No):593-601. [Medline].
Guinan ME, Thomas PA, Pinsky PF, Goodrich JT, Selik RM, Jaffe HW. Heterosexual and homosexual patients with the acquired immunodeficiency syndrome. A comparison of surveillance, interview, and laboratory data. Ann Intern Med. 1984 Feb. 100(2):213-8. [Medline].
Hodson EM, Jones CA, Webster AC, Strippoli GF, Barclay PG, Kable K. Antiviral medications to prevent cytomegalovirus disease and early death in recipients of solid-organ transplants: a systematic review of randomised controlled trials. Lancet. 2005 Jun 18-24. 365(9477):2105-15. [Medline].
Staras SA, Dollard SC, Radford KW, Flanders WD, Pass RF, Cannon MJ. Seroprevalence of cytomegalovirus infection in the United States, 1988-1994. Clin Infect Dis. 2006 Nov 1. 43(9):1143-51. [Medline].
Bate SL, Dollard SC, Cannon MJ. Cytomegalovirus seroprevalence in the United States: the national health and nutrition examination surveys, 1988-2004. Clin Infect Dis. 2010 Jun 1. 50(11):1439-47. [Medline].
Ljungman P, Griffiths P, Paya C. Definitions of cytomegalovirus infection and disease in transplant recipients. Clin Infect Dis. 2002 Apr 15. 34(8):1094-7. [Medline].
Cunha BA. Cytomegalovirus pneumonia: community-acquired pneumonia in immunocompetent hosts. Infect Dis Clin North Am. 2010 Mar. 24(1):147-58. [Medline].
Deayton JR, Prof Sabin CA, Johnson MA, Emery VC, Wilson P, Griffiths PD. Importance of cytomegalovirus viraemia in risk of disease progression and death in HIV-infected patients receiving highly active antiretroviral therapy. Lancet. 2004 Jun 26. 363(9427):2116-21. [Medline].
Stagno S, Pass RF, Cloud G, Britt WJ, Henderson RE, Walton PD. Primary cytomegalovirus infection in pregnancy. Incidence, transmission to fetus, and clinical outcome. JAMA. 1986 Oct 10. 256(14):1904-8. [Medline].
Stagno S. Cytomegalovirus. Remington JS, Klein JO. Infectious Diseases of the Fetus and Newborn Infant. Philadelphia: WB Saunders; 2001. 389-424.
Arora N, Novak Z, Fowler KB, Boppana SB, Ross SA. Cytomegalovirus viruria and DNAemia in healthy seropositive women. J Infect Dis. 2010 Dec 15. 202(12):1800-3. [Medline]. [Full Text].
Walter EA, Greenberg PD, Gilbert MJ. Reconstitution of cellular immunity against cytomegalovirus in recipients of allogeneic bone marrow by transfer of T-cell clones from the donor. N Engl J Med. 1995 Oct 19. 333(16):1038-44. [Medline].
Bonkowsky HL, Lee RV, Klatskin G. Acute granulomatous hepatitis. Occurrence in cytomegalovirus mononucleosis. JAMA. 1975 Sep 22. 233(12):1284-8. [Medline].
Meiselman MS, Cello JP, Margaretten W. Cytomegalovirus colitis. Report of the clinical, endoscopic, and pathologic findings in two patients with the acquired immune deficiency syndrome. Gastroenterology. 1985 Jan. 88(1 Pt 1):171-5. [Medline].
Orlikowski D, Porcher R, Sivadon-Tardy V, et al. Guillain-Barre Syndrome following Primary Cytomegalovirus Infection: A Prospective Cohort Study. Clin Infect Dis. 2011 Apr. 52(7):837-44. [Medline].
Jabs DA, Van Natta ML, Kempen JH, Reed Pavan P, Lim JI, Murphy RL, et al. Characteristics of patients with cytomegalovirus retinitis in the era of highly active antiretroviral therapy. Am J Ophthalmol. 2002 Jan. 133(1):48-61. [Medline].
Karavellas MP, Plummer DJ, Macdonald JC, Torriani FJ, Shufelt CL, Azen SP. Incidence of immune recovery vitritis in cytomegalovirus retinitis patients following institution of successful highly active antiretroviral therapy. J Infect Dis. 1999 Mar. 179(3):697-700. [Medline].
Wohl DA, Kendall MA, Owens S, Holland G, Nokta M, Spector SA. The safety of discontinuation of maintenance therapy for cytomegalovirus (CMV) retinitis and incidence of immune recovery uveitis following potent antiretroviral therapy. HIV Clin Trials. 2005 May-Jun. 6(3):136-46. [Medline].
Wright ME, Suzman DL, Csaky KG, Masur H, Polis MA, Robinson MR. Extensive retinal neovascularization as a late finding in human immunodeficiency virus-infected patients with immune recovery uveitis. Clin Infect Dis. 2003 Apr 15. 36(8):1063-6. [Medline].
Richardson WP, Colvin RB, Cheeseman SH. Glomerulopathy associated with cytomegalovirus viremia in renal allografts. N Engl J Med. 1981 Jul 9. 305(2):57-63. [Medline].
Torok-Storb B, Boeckh M, Hoy C. Association of specific cytomegalovirus genotypes with death from myelosuppression after marrow transplantation. Blood. 1997 Sep 1. 90(5):2097-102. [Medline].
Manuel O, Asberg A, Pang X, Rollag H, Emery VC, Preiksaitis JK. Impact of genetic polymorphisms in cytomegalovirus glycoprotein B on outcomes in solid-organ transplant recipients with cytomegalovirus disease. Clin Infect Dis. 2009 Oct 15. 49(8):1160-6. [Medline].
Iwasenko JM, Howard J, Arbuckle S, et al. Human cytomegalovirus infection is detected frequently in stillbirths and is associated with fetal thrombotic vasculopathy. J Infect Dis. 2011 Jun. 203(11):1526-33. [Medline].
Klemola E, Von Essen R, Henle G, Henle W. Infectious-mononucleosis-like disease with negative heterophil agglutination test. Clinical features in relation to Epstein-Barr virus and cytomegalovirus antibodies. J Infect Dis. 1970 Jun. 121(6):608-14. [Medline].
Cohen JI, Corey GR. Cytomegalovirus infection in the normal host. Medicine (Baltimore). 1985 Mar. 64(2):100-14. [Medline].
Horwitz CA, Henle W, Henle G. Clinical and laboratory evaluation of cytomegalovirus-induced mononucleosis in previously healthy individuals. Report of 82 cases. Medicine (Baltimore). 1986 Mar. 65(2):124-34. [Medline].
Klemola E, Stenström R, von Essen R. Pneumonia as a clinical manifestation of cytomegalovirus infection in previously healthy adults. Scand J Infect Dis. 1972. 4(1):7-10. [Medline].
Jaber S, Chanques G, Borry J, Souche B, Verdier R, Perrigault PF. Cytomegalovirus infection in critically ill patients: associated factors and consequences. Chest. 2005 Jan. 127(1):233-41. [Medline].
von Müller L, Klemm A, Weiss M, et al. Active cytomegalovirus infection in patients with septic shock. Emerg Infect Dis. 2006 Oct. 12(10):1517-22. [Medline]. [Full Text].
Kalil AC, Florescu DF. Prevalence and mortality associated with cytomegalovirus infection in nonimmunosuppressed patients in the intensive care unit. Crit Care Med. 2009 Aug. 37(8):2350-8. [Medline].
Cook CH, Yenchar JK, Kraner TO, Davies EA, Ferguson RM. Occult herpes family viruses may increase mortality in critically ill surgical patients. Am J Surg. 1998 Oct. 176(4):357-60. [Medline].
De Vlieger G, Meersseman W, Lagrou K, et al. Cytomegalovirus serostatus and outcome in nonimmunocompromised critically ill patients. Crit Care Med. 2012 Jan. 40(1):36-42. [Medline].
Kim JM, Kim SJ, Joh JW, et al. Is cytomegalovirus infection dangerous in cytomegalovirus-seropositive recipients after liver transplantation?. Liver Transpl. 2011 Apr. 17(4):446-55. [Medline].
Rubin RH. The indirect effects of cytomegalovirus infection on the outcome of organ transplantation. JAMA. 1989 Jun 23-30. 261(24):3607-9. [Medline].
Fishman JA, Rubin RH. Infection in organ-transplant recipients. N Engl J Med. 1998 Jun 11. 338(24):1741-51. [Medline].
Snydman DR. Infection in solid organ transplantation. Transpl Infect Dis. 1999 Mar. 1(1):21-8. [Medline].
Johanssson I, Mårtensson G, Andersson R. Cytomegalovirus and long-term outcome after lung transplantation in Gothenburg, Sweden. Scand J Infect Dis. 2010. 42(2):129-36. [Medline].
Reed EC, Bowden RA, Dandliker PS. Treatment of cytomegalovirus pneumonia with ganciclovir and intravenous cytomegalovirus immunoglobulin in patients with bone marrow transplants. Ann Intern Med. 1988 Nov 15. 109(10):783-8. [Medline].
Eid AJ, Arthurs SK, Deziel PJ, Wilhelm MP, Razonable RR. Clinical predictors of relapse after treatment of primary gastrointestinal cytomegalovirus disease in solid organ transplant recipients. Am J Transplant. 2010 Jan. 10(1):157-61. [Medline].
Dieterich DT, Rahmin M. Cytomegalovirus colitis in AIDS: presentation in 44 patients and a review of the literature. J Acquir Immune Defic Syndr. 1991. 4 Suppl 1:S29-35. [Medline].
McCutchan JA. Cytomegalovirus infections of the nervous system in patients with AIDS. Clin Infect Dis. 1995 Apr. 20(4):747-54. [Medline].
Anti-Cytomegalovirus (CMV) Immediate Early Antigen Monoclonal Antibody, Unconjugated, Clone 3G9.2 from CHEMICON. www.chemicon.com. Available at http://www.bio-medicine.org/biology-products/Anti-Cytomegalovirus--28CMV-29-Immediate-Early-Antigen-Monoclonal-Antibody--Unconjugated--Clone-3G9-2-from-CHEMICON-2132-1/. Accessed: March 17, 2010.
Martín-Dávila P, Fortún J, Gutiérrez C, Martí-Belda P, Candelas A, Honrubia A, et al. Analysis of a quantitative PCR assay for CMV infection in liver transplant recipients: an intent to find the optimal cut-off value. J Clin Virol. 2005 Jun. 33(2):138-44. [Medline].
Aitken C, Barrett-Muir W, Millar C, Templeton K, Thomas J, Sheridan F. Use of molecular assays in diagnosis and monitoring of cytomegalovirus disease following renal transplantation. J Clin Microbiol. 1999 Sep. 37(9):2804-7. [Medline]. [Full Text].
Gerna G, Zipeto D, Parea M, Revello MG, Silini E, Percivalle E. Monitoring of human cytomegalovirus infections and ganciclovir treatment in heart transplant recipients by determination of viremia, antigenemia, and DNAemia. J Infect Dis. 1991 Sep. 164(3):488-98. [Medline].
Tanabe K, Tokumoto T, Ishikawa N, Koyama I, Takahashi K, Fuchinoue S. Comparative study of cytomegalovirus (CMV) antigenemia assay, polymerase chain reaction, serology, and shell vial assay in the early diagnosis and monitoring of CMV infection after renal transplantation. Transplantation. 1997 Dec 27. 64(12):1721-5. [Medline].
Boppana SB, Ross SA, Shimamura M, Palmer AL, Ahmed A, Michaels MG, et al. Saliva polymerase-chain-reaction assay for cytomegalovirus screening in newborns. N Engl J Med. 2011 Jun 2. 364(22):2111-8. [Medline]. [Full Text].
Sanghavi SK, Abu-Elmagd K, Keightley MC, St George K, Lewandowski K, Boes SS. Relationship of cytomegalovirus load assessed by real-time PCR to pp65 antigenemia in organ transplant recipients. J Clin Virol. 2008 Aug. 42(4):335-42. [Medline].
Jabs DA, Martin BK, Forman MS, Ricks MO. Cytomegalovirus (CMV) blood DNA load, CMV retinitis progression, and occurrence of resistant CMV in patients with CMV retinitis. J Infect Dis. 2005 Aug 15. 192(4):640-9. [Medline].
Roche Molecular Diagnostics. COBAS AMPLICOR CMV MONITOR test. Available at http://molecular.roche.com/assays/Pages/COBASAMPLICORCMVMONITORTest.aspx. Accessed: July 10, 2012.
Roche Molecular Diagnostics. COBAS AmpliPrep/COBAS TaqMan CMV test. Available at http://molecular.roche.com/assays/Pages/COBASAmpliPrepCOBASTaqManCMVTest.aspx. Accessed: July 10, 2012.
Smith TF, Espy MJ, Mandrekar J, Jones MF, Cockerill FR, Patel R. Quantitative real-time polymerase chain reaction for evaluating DNAemia due to cytomegalovirus, Epstein-Barr virus, and BK virus in solid-organ transplant recipients. Clin Infect Dis. 2007 Oct 15. 45(8):1056-61. [Medline].
Drew WL. Cytomegalovirus resistance testing: pitfalls and problems for the clinician. Clin Infect Dis. 2010 Mar 1. 50(5):733-6. [Medline].
Drew WL, Miner R, Saleh E. Antiviral susceptibility testing of cytomegalovirus: criteria for detecting resistance to antivirals. Clin Diagn Virol. 1993 Aug. 1(3):179-85. [Medline].
Lischka P, Hewlett G, Wunberg T, Baumeister J, Paulsen D, Goldner T, et al. In vitro and in vivo activities of the novel anticytomegalovirus compound AIC246. Antimicrob Agents Chemother. 2010 Mar. 54 (3):1290-7. [Medline].
Melendez DP, Razonable RR. Letermovir and inhibitors of the terminase complex: a promising new class of investigational antiviral drugs against human cytomegalovirus. Infect Drug Resist. 2015 Aug 5. 8:269-77. [Medline].
Bodro M, Sabé N, Lladó L, et al. Prophylaxis versus preemptive therapy for cytomegalovirus disease in high-risk liver transplant recipients. Liver Transpl. 2012 Sep. 18(9):1093-9. [Medline].
Witzke O, Hauser IA, Bartels M, Wolf G, Wolters H, Nitschke M. Valganciclovir prophylaxis versus preemptive therapy in cytomegalovirus-positive renal allograft recipients: 1-year results of a randomized clinical trial. Transplantation. 2012 Jan 15. 93(1):61-8. [Medline].
Fishman JA, Emery V, Freeman R, Pascual M, Rostaing L, Schlitt HJ. Cytomegalovirus in transplantation - challenging the status quo. Clin Transplant. 2007 Mar-Apr. 21(2):149-58. [Medline].
Legendre C, Pascual M. Improving outcomes for solid-organ transplant recipients at risk from cytomegalovirus infection: late-onset disease and indirect consequences. Clin Infect Dis. 2008 Mar 1. 46(5):732-40. [Medline].
No authors listed. Valganciclovir: new preparation. CMV retinitis: a simpler, oral treatment. Prescrire Int. 2003 Aug. 12(66):133-5. [Medline].
Caldés A, Gil-Vernet S, Armendariz Y, Colom H, Pou L, Niubó J, et al. Sequential treatment of cytomegalovirus infection or disease with a short course of intravenous ganciclovir followed by oral valganciclovir: efficacy, safety, and pharmacokinetics. Transpl Infect Dis. 2009 Dec 9. [Medline].
Dieterich DT, Chachoua A, Lafleur F. Ganciclovir treatment of gastrointestinal infections caused by cytomegalovirus in patients with AIDS. Rev Infect Dis. 1988 Jul-Aug. 10 Suppl 3:S532-7. [Medline].
Kalil AC, Mindru C, Florescu DF. Effectiveness of valganciclovir 900 mg versus 450 mg for cytomegalovirus prophylaxis in transplantation: direct and indirect treatment comparison meta-analysis. Clin Infect Dis. 2011 Feb. 52(3):313-21. [Medline].
Avery RK. Low-dose valganciclovir for cytomegalovirus prophylaxis in organ transplantation: is less really more?. Clin Infect Dis. 2011 Feb. 52(3):322-4. [Medline].
Cytomegalovirus. Am J Transplant. 2004 Nov. 4 Suppl 10:51-8. [Medline].
Paudice N, Mehmetaj A, Zanazzi M, Moscarelli L, Piperno R, Di Maria L. Preemptive therapy for the prevention of cytomegalovirus disease in renal transplant recipients: our preliminary experience. Transplant Proc. 2009 May. 41(4):1204-6. [Medline].
Boeckh M, Gooley TA, Myerson D. Cytomegalovirus pp65 antigenemia-guided early treatment with ganciclovir versus ganciclovir at engraftment after allogeneic marrow transplantation: a randomized double-blind study. Blood. 1996 Nov 15. 88(10):4063-71. [Medline].
Avery RK, Marty FM, Strasfeld L, Lee I, Arrieta A, Chou S. Oral maribavir for treatment of refractory or resistant cytomegalovirus infections in transplant recipients. Transpl Infect Dis. 2010 Dec. 12(6):489-96. [Medline].
Marty FM, Ljungman P, Papanicolaou GA, Winston DJ, Chemaly RF, Strasfeld L. Maribavir prophylaxis for prevention of cytomegalovirus disease in recipients of allogeneic stem-cell transplants: a phase 3, double-blind, placebo-controlled, randomised trial. Lancet Infect Dis. 2011 Apr. 11(4):284-92. [Medline].
Trofe J, Pote L, Wade E, Blumberg E, Bloom RD. Maribavir: a novel antiviral agent with activity against cytomegalovirus. Ann Pharmacother. 2008 Oct. 42(10):1447-57. [Medline].
John GT, Manivannan J, Chandy S, Peter S, Jacob CK. Leflunomide therapy for cytomegalovirus disease in renal allograft recepients. Transplantation. 2004 May 15. 77(9):1460-1. [Medline].
John GT, Manivannan J, Chandy S, Peter S, Fleming DH, Chandy SJ, et al. A prospective evaluation of leflunomide therapy for cytomegalovirus disease in renal transplant recipients. Transplant Proc. 2005 Dec. 37(10):4303-5. [Medline].
Levi ME, Mandava N, Chan LK, Weinberg A, Olson JL. Treatment of multidrug-resistant cytomegalovirus retinitis with systemically administered leflunomide. Transpl Infect Dis. 2006 Mar. 8(1):38-43. [Medline].
Battiwalla M, Paplham P, Almyroudis NG, McCarthy A, Abdelhalim A, Elefante A. Leflunomide failure to control recurrent cytomegalovirus infection in the setting of renal failure after allogeneic stem cell transplantation. Transpl Infect Dis. 2007 Mar. 9(1):28-32. [Medline].
Valantine HA, Luikart H, Doyle R, Theodore J, Hunt S, Oyer P. Impact of cytomegalovirus hyperimmune globulin on outcome after cardiothoracic transplantation: a comparative study of combined prophylaxis with CMV hyperimmune globulin plus ganciclovir versus ganciclovir alone. Transplantation. 2001 Nov 27. 72(10):1647-52. [Medline].
Price NB, Prichard MN. Progress in the development of new therapies for herpesvirus infections. Curr Opin Virol. 2011 Dec. 1(6):548-54. [Medline].
Torres-Madriz G, Boucher HW. Immunocompromised hosts: perspectives in the treatment and prophylaxis of cytomegalovirus disease in solid-organ transplant recipients. Clin Infect Dis. 2008 Sep 1. 47(5):702-11. [Medline].
Wolf DG, Shimoni A, Resnick IB, Stamminger T, Neumann AU, Chou S. Human cytomegalovirus kinetics following institution of artesunate after hematopoietic stem cell transplantation. Antiviral Res. 2011 Jun. 90(3):183-6. [Medline].
Shapira MY, Resnick IB, Chou S, et al. Artesunate as a potent antiviral agent in a patient with late drug-resistant cytomegalovirus infection after hematopoietic stem cell transplantation. Clin Infect Dis. 2008 May 1. 46(9):1455-7. [Medline].
Kaul DR, Stoelben S, Cober E, Ojo T, Sandusky E, Lischka P. First report of successful treatment of multidrug-resistant cytomegalovirus disease with the novel anti-CMV compound AIC246. Am J Transplant. 2011 May. 11(5):1079-84. [Medline].
Go V, Pollard RB. A cytomegalovirus vaccine for transplantation: are we closer?. J Infect Dis. 2008 Jun 15. 197(12):1631-3. [Medline].
Schleiss MR. A cytomegalovirus vaccine tames the troll of transplantation. Lancet. 2011 Apr 9. 377(9773):1216-8. [Medline].
Pass RF, Zhang C, Evans A, Simpson T, Andrews W, Huang ML, et al. Vaccine prevention of maternal cytomegalovirus infection. N Engl J Med. 2009 Mar 19. 360(12):1191-9. [Medline]. [Full Text].
Shanahan A, Malani PN, Kaul DR. Relapsing cytomegalovirus infection in solid organ transplant recipients. Transpl Infect Dis. 2009 Dec. 11(6):513-8. [Medline].
Alexander BT, Hladnik LM, Augustin KM, Casabar E, McKinnon PS, Reichley RM. Use of cytomegalovirus intravenous immune globulin for the adjunctive treatment of cytomegalovirus in hematopoietic stem cell transplant recipients. Pharmacotherapy. 2010 Jun. 30(6):554-61. [Medline].
Angela M Caliendo, MD, PhD. Viral load testing for cytomegalovirus in solid organ transplant recipients. Available at http://www.uptodate.com/online/content/topic.do?topicKey=viral_in/21207&selectedTitle=6%7E150&source=search_result#H2. Accessed: July 11, 2013.
Avery RK, Bolwell BJ, Yen-Lieberman B, et al. Use of leflunomide in an allogeneic bone marrow transplant recipient with refractory cytomegalovirus infection. Bone Marrow Transplant. 2004 Dec. 34(12):1071-5. [Medline].
Avery RK, Mossad SB, Poggio E, Lard M, Budev M, Bolwell B. Utility of leflunomide in the treatment of complex cytomegalovirus syndromes. Transplantation. 2010 Aug 27. 90(4):419-26. [Medline].
Bueno J, Ramil C, Green M. Current management strategies for the prevention and treatment of cytomegalovirus infection in pediatric transplant recipients. Paediatr Drugs. 2002. 4(5):279-90. [Medline].
Cesaro S, Zhou X, Manzardo C, Buonfrate D, Cusinato R, Tridello G. Cidofovir for cytomegalovirus reactivation in pediatric patients after hematopoietic stem cell transplantation. J Clin Virol. 2005 Oct. 34(2):129-32. [Medline].
Cunha BA, Gouzhva O, Nausheen S. Severe cytomegalovirus (CMV) community-acquired pneumonia (CAP) precipitating a systemic lupus erythematosus (SLE) flare. Heart Lung. 2009 May-Jun. 38(3):249-52. [Medline].
Cunha BA, Pherez F, Walls N. Severe cytomegalovirus (CMV) community-acquired pneumonia (CAP) in a nonimmunocompromised host. Heart Lung. 2009 May-Jun. 38(3):243-8. [Medline].
Kling J. Cidofovir Showing Promise for Resistant Cytomegalovirus. Available at http://www.medscape.com/viewarticle/811494. Accessed: October 7, 2013.
Schleiss MR. VCL-CB01, an injectable bivalent plasmid DNA vaccine for potential protection against CMV disease and infection. Curr Opin Mol Ther. 2009 Oct. 11(5):572-8. [Medline].
Thorne JE, Jabs DA, Kempen JH, Holbrook JT, Nichols C, Meinert CL. Causes of visual acuity loss among patients with AIDS and cytomegalovirus retinitis in the era of highly active antiretroviral therapy. Ophthalmology. 2006 Aug. 113(8):1441-5. [Medline].
Wloch MK, Smith LR, Boutsaboualoy S, Reyes L, Han C, Kehler J. Safety and immunogenicity of a bivalent cytomegalovirus DNA vaccine in healthy adult subjects. J Infect Dis. 2008 Jun 15. 197(12):1634-42. [Medline].

Media Gallery

Here, using immunofluorescent technique, a specimen of human embryonic lung (25X) reveals the presence of cytomegalovirus. Courtesy of the CDC and Dr Craig Lyerla.
Hematoxylin-eosin–stained lung section showing typical owl-eye inclusions (480X). Courtesy of Danny L Wiedbrauk, PhD, Scientific Director, Virology & Molecular Biology, Warde Medical Laboratory, Ann Arbor, Michigan.

of 2

Author

Kauser Akhter, MD Assistant Professor, Department of Internal Medicine, Florida State University College of Medicine; Associate Program Director, Infectious Diseases Fellowship Program, Orlando Health

Disclosure: Nothing to disclose.

Coauthor(s)

Todd S Wills, MD Associate Professor, Department of Medicine, Division of Infectious Disease and International Medicine, Program Director, Infectious Disease Fellowship Program, University of South Florida College of Medicine

Todd S Wills, MD is a member of the following medical societies: Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John W King, MD Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University Health Sciences Center; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center

John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, Association of Subspecialty Professors, American Society for Microbiology, Infectious Diseases Society of America, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthor Todd S Wills, MD to the development and writing of this article.

Sections Cytomegalovirus
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
Follow-up
Media Gallery
References

Cytomegalovirus Medication

Medication Summary

Antivirals

Class Summary

Ganciclovir (Cytovene)

Foscarnet (Foscavir)

Cidofovir (Vistide)

Valganciclovir (Valcyte)

Immune Globulin

Class Summary

Cytomegalovirus immune globulin (CMV IG)

Antimetabolite

Class Summary

Leflunomide (Arava)

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Cytomegalovirus Medication

Medication Summary

Antivirals

Class Summary

Ganciclovir (Cytovene)

Foscarnet (Foscavir)

Cidofovir (Vistide)

Valganciclovir (Valcyte)

Immune Globulin

Class Summary

Cytomegalovirus immune globulin (CMV IG)

Antimetabolite

Class Summary

Leflunomide (Arava)

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