Cytomegalovirus prevention

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. 

Ganciclovir IV is indicated for use only in the treatment of cytomegalovirus (CMV) retinitis in immunocompromised patients and for the prevention of CMV disease in transplant patients at risk for CMV disease. 

Strippoli, G.F., Hodson, E.M., Jones, C. and Craig, J.C. (2006) Preemptive treatment for cytomegalovirus viraemia to prevent cytomegalovirus disease in solid organ transplant recipients. Transplantation, 81, 139-145. 

Cytomegalovirus (CMV) retinitis in patients with normal renal function PO Initially, 900 mg (two 450-mg tablets) twice a dayfor 21 days. Maintenance 900 mg once a day. Prevention of CMV after transplant PO 900 mg once a day beginning within 10 days of transplant and continuing until 100 days post-transplant. 

Hodson EM, Jones CA, Webster AC, et al. Antiviral medications to prevent cytomegalovirus disease and early death in recipients of solid-organ transplants a systematic review of randomized controlled trials. Lancet. 2005 365 2105-2115. 

Reischig T, Opatrny K, Jr, Treska V, et al. Prospective comparison of valacyclovir and oral ganciclovir for prevention of cytomegalovirus disease in high-risk renal transplant recipients. Kidney Blood Press Res. 2005 28 218-22 5. 

In contrast to antibacterial antibiotic therapy, inhibition of viral replication is usually difficult to achieve. Therefore preventive strategies, such as vaccination, are frequendy more successful and clinically important. However, vaccines are not available for all viruses furthermore, some viruses, such as Epstein-Barr virus (EBV) and cytomegalovirus (CMV), are ubiquitously present and usually not very pathogenic unless in an immunocompromised host. One strategy to combat viral infecdons in the immunocompromised host is the application of neutralizing mAbs. One such mAh is directed to the F protein of the respiratory syncytial virus (RSV), which afflicts premature newborns with often severe pulmonary infections this mAh appears to be useful in such situations (91). Other mAbs to viral antigens are in development. 

Pujol et al. in chapter eight, reviews the chemistry, origin and antiviral activities of naturally occurring sulfated polysaccharides for the prevention and control of viral infections such as HIV-1 and -2, human cytomegalovirus (HCMV), dengue virus (DENV), respiratory syncytial virus (RSV), and influenza A virus. 

LF has been demonstrated to inhibit in vitro the multiplication of different viruses, such as human cytomegalovirus, HIV, herpes simplex viruses 1 and 2, influenza virus, human hepatitis C virus and human poliovirus type 1 (Vorland, 1999). Also, LF has been shown to prevent rotavirus infection in the human enterocyte-like cell-line HT-29 (Superti et al., 1997). It is speculated that LF prevents the binding of viruses to the host cells by... 

A number of DNA vaccines have progressed into clinical trials for the prevention and/or treatment of HIV, malaria, cytomegalovirus (CMV) and hepatitis B and C [23,24], So far the DNA vaccines have been well tolerated in clinical trials [23] and have produced both humoral and cellular responses in some trials [41], but overall the potency has been disappointing [20], Although DNA is typically injected intramuscularly, alternative delivery systems have been evaluated. One such system that has been tested clinically for hepatitis B involves coating plasmid DNA onto gold beads, which are then propelled into the epidermis using a needle-free delivery system [20,42,43],... 

Transplantation Study Group. Valacyclovir for the prevention of cytomegalovirus disease after renal transplantation. N Engl J Med 1999 340(19) 1462-70. 

Pulmonary delivery could also be used for delivery of vaccines. In the United States alone, children endure as many as 14 vaccine injections by age 16 and that number is climbing as new research makes more vaccines available. The cost of a single injection can quadruple if the costs of equipment and personnel are included. Furthermore, fear of needles reduces compliance, thus the potential for an increased market share in this area. Inhaled vaccines may be used to prevent influenza, pneumonia, tuberculosis, measles, cytomegalovirus, asthma, and mucosal-entry diseases such as sexually transmitted diseases including HIV. 

Yeager AS, Grumet FC, Hafleigh EB, Arvui AM, Bradley JS, Prober CG. Prevention of transfusion-acquired cytomegalovirus infections in newborn infants. J Pediatr 1981 98(2) 281-7. 

Bowden RA, Slichter SJ, Sayers MH, Mori M, Cays MJ, Meyers JD. Use of leukocyte-depleted platelets and cytomegalovirus-seronegative red blood cells for prevention of primary cytomegalovirus infection after marrow transplant. Blood 1991 78(l) 246-50. 

Eisenfeld L, Silver H, McLaughlin J, Klevjer-Anderson P, Mayo D, Anderson J, Herson V, Krause P, Savidakis J, Lazar A, et al. Prevention of transfusion-associated cytomegalovirus infection in neonatal patients by the removal of white cells from blood. Transfusion 1992 32(3) 205-9. 

Specific immunoglobulins, termed hyperimmune globulins, are derived from human donors known to have high titers of the desired antibody. Specific immunoglobulin preparations for use in infectious disease prevention include hepatitis B, rabies, tetanus. Varicella zoster, vaccinia, and cytomegalovirus immunoglobulin. 

Weinberg A, Hodges TN, Li S, Cai G, Zamora MR, Comparison of PCR, antigenemia assay, and rapid blood culture for detection and prevention of cytomegalovirus disease after lung transplantation. 

Meyers JD, Reed EC, Shepp DH, et al. Acyclovir for prevention of cytomegalovirus infection and disease after allogeneic marrow transplantation. N Engl J Med 1988 318 70-75. 

---