Ganciclovir infection risk

Ganciclovir capsules are indicated only for prevention of CMV disease in patients with advanced HIV infection at risk for CMV disease and for maintenance treatment of CMV retinitis in immunocompromised patients. 

Lactation It is not known whether ganciclovir or valganciclovir is excreted in human milk. Because of potential for serious adverse events in nursing infants, mothers should be instructed not to breastfeed if they are receiving valganciclovir tablets. In addition, the Centers for Disease Control and Prevention recommend that HIV-infected mothers not breastfeed their infants to avoid risking postnatal transmission of HIV. 

Intravenous ganciclovir is indicated for the treatment of CMV retinitis in immunocompromised individuals, including those with AIDS, and for the prevention of CMV infection in organ transplant recipients. Oral ganciclovir is less effective than the intravenous preparation but carries a lower risk of adverse effects. It is... 

Adjunctive prophylaxis with ganciclovir in CMV-positive patients or in recipients of CMV-positive organs may be effective in reducing risk of CM V infection. 

There are some relative contraindications to use of the ganciclovir implant. The risk of using the implant in an individual with limited life expectancy should be carefully considered, although the immune status can be markedly improved with HAART. Other relative contraindications include implantation when there is an ocular surface infection or systemic coagulopathy. Extraocular ganciclovir resistant viral strains may be a relative contraindication, although more than one strain of CMY can infect an individual and the resistant isolate from the blood or extraocular tissue may not reflect the CMV strain in the eye (116). 

Palmer SM, Grinnan DC, Diane Reams B, Steele MP, Messier RH, Duane Davis R (2004) Delay of CMV infection in high-risk CMV mismatch lung transplant recipients due to prophylaxis with oral ganciclovir. Clin Transplant 18 179-185... 

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