Cytomegalovirus infection treatment

Fischler B, Casswall TH, Malmborg P, Nemeth A. Ganciclovir treatment in infants with cytomegalovirus infection and cholestasis. J Pediatr Gastroenterol Nutr 2002 34(2) 154-7. 

It is used in the treatment of cytomegalovirus infections in immunocompromised patients... 

The treatment for smallpox is primarily supportive. Research is ongoing into antiviral therapies for smallpox but currently therapy for patients infected with smallpox remains supportive, with intravenous fluids, pain medications, and antibiotics as needed for secondary bacterial infections (Henderson, 1999). Cidofovir, an antiviral agent used primarily against cytomegalovirus infection, has shown some promise against orthopox viruses such as vaccinia and cowpox in animal studies (De Clercq, 2002). Currently it is approved in its IV form for use in the treatment of adverse effects of smallpox vaccination (CDC, 2003). 

Valacyclovir is indicated for the treatment of herpes zoster (shingles), for the treatment of initial and recurrent episodes of genital herpes, and for the suppression of recurrent genital herpes in immunocompetent and HIV-infected patients. It is also indicated for the reduction of transmission of genital herpes in immunocompetent individuals, and for the treatment of cold sores. Valacyclovir appears to be equally effective in treating herpes zoster and recurrent genital herpes in immunocompetent adults. Valacyclovir has shown efficacy in the prophylaxis of cytomegalovirus infections in transplant patients (Perry and Faulds, 1996). 

Blanshard C, Benhamou Y, Dohin E, Lernestedt JO, Gazzard BG, Katlama C. Treatment of AIDS-associated gastrointestinal cytomegalovirus infection with foscarnet and ganciclovir a randomized comparison. J Infect Dis 1995 172(3) 622-8. 

Patients who have undergone renal transplantation and then require treatment for cytomegalovirus infection are at special risk of renal damage due to foscarnet. 

Collaborative DHPG Treatment Study Group. Treatment of serious cytomegalovirus infections with 9-(l,3-dihydroxy-2-propoxymethyl)guanine in patients with AIDS and other immunodeficiencies. N Engl J Med 1986 314(13) 801-5. 

Ganciclovir is an acyclic nucleoside analogue of guanine that is structurally similar to acyclovir, but is more effective in the treatment and prophylaxis of severe cytomegalovirus infection in immunocompromised hosts. Ganciclovir is myelotoxic, but has no significant nephrotoxicity [22]. It does, however, require dose adjustment for patients with reduced kidney function. 

Ringden O, Lonnqvist B, Paulin T, Ahimen J, Klintmalm G, Wahren B, Lernestedt J-0. Pharmacokinetics, safety and preliminary clinical experiences using foscarnet in the treatment of cytomegalovirus infections in bone marrow and renal transplant recipients. J Antimicrob Chemother 1986 17 373-387. 

Buhles WC, Mastre BJ, Tinker AJ, et al. Ganciclovir treatment of life- or sight-threatening cytomegalovirus infection experience with 314 immunocompromised patients. Rev Infect Dis 1988 10 495. 

Foscarnet (trisodium phosphonoformate) is an inorganic pyrophosphate analog, which inhibits many DNA polymerases, retroviral reverse transcriptase, and some RNA polymerases, and has antiviral activity against all of the herpes viruses and HIV. Foscarnet has been used primarily for the treatment of serious cytomegalovirus infection. 

It is broadly employed for the treatment of herpes zoster, herpetic-keratitis, herpes genitalis, chronic hepatitis, common cold and influenza. It also finds its usefulness in limg carcinoma, breast cancer, multiple myelomas. It is also recommended as a prophylactic agent in cytomegalovirus infection in renal transplant patients. 

The first antisense therapeutic agent to reach the market is fomivirsen (ISIS 2922) (19). Fomivirsen is a 21-mer phosphorothioate oligodeoxynucleotide (Fig. 8.5). It inhibits human cytomegalovirus (CMV), a ubiquitous herpesvirus that is the most common cause of viral retinitis in immunocompromised patients, especially those with FIIV infection. Cytomegalovirus infection is characterized by the progressive destruction of retinal cells and, if untreated, leads to retinal detachment and blindness. Even with treatment, some degree of visual loss occurs in nearly all patients with a diagnosis of CMV retinitis. It can affect one or both eyes. 

A man with a kidney transplant taking corticosteroids and ciclosporin developed a cytomegalovirus infection that was treated with foscarnet 85 mg/kg daily. Despite efforts to minimise the nephrotoxic effects of the foscarnet (hydration with 2.5 litres of isotonic saline daily and nifedipine 80 mg the day before and during treatment) the patient developed non-ol-iguric worsening of his renal function after 8 days. Nine days after stopping the foscamet, the former renal function was restored. ... 

Schindler C, Shuai K, Prezioso VR, Darnell JE (1992) Interferon-dependent tyrosine phosphorylation of a latent cytoplasmic transcription factor. Science 257 809-813 Scholz M, Hamann A, Blaheta RA. Auth MK, Encke A, Markus BH (1992) Cytomegalovirus- and interferon-related effects on human endothelial cells cytomegalovirus infection reduces upregulation of HLA class II antigen expression after treatment with interferon-gamma. Hum Immunol 35 230-238... 

In a retrospective case-series of 23 infants with culture-proven congenital cytomegalovirus infection who had been treated with ganciclovir for 6 weeks, followed by oral valganciclovir to the age of 12 months, the most common adverse reaction was neutropenia ( =12) it was severe in two infants, with absolute neutrophil counts below 500 X 10 /1 [12 ]. Treatment was withheld imtil the neutrophil count returned to normal no further intervention was required. Neutropenia occurred only within the first 3 months of treatment and mainly during the first 6 weeks of intravenous ganciclovir administration. 

Amir J, Wolf DG, Levy L Treatment of symptomatic congenital cytomegalovirus infection with intravenous ganddovir followed by long-term oral valgandclovir. Eur J Pediatr 2010 169(9) 1061-7. 

Caldes A, Gil-Vemet S, Armendariz Y, Colom H, Pou L, Niubo J, Uado L, Torras J, Manito N, Ruff G, Grinyo JM. Sequential treatment of cytomegalovirus infection or disease with a short course of intravenous ganciclovir followed by oral valgandclovir efficacy, safety, and pharmacokinetics. Transpl Infect Dis 2010 12 (3) 204-12. 

Antiviral drugp interfere with viral reproduction by altering DNA synthesis. These drug are used in the treatment of herpes simplex infections of the eye, treatment in immunocompromised patients with cytomegalovirus (CMV) retinitis, and for the prevention of CMV retinitis in patients undergoing transplant. 

---