Overview of congenitally and perinatally acquired cytomegalovirus infections: recent advances in antiviral therapy

Abstract

Congenital and perinatal infection with human cytomegalovirus (CMV) are commonly encountered in newborns. In recent years there has been increased awareness of the disabilities that result from congenital CMV infection, which in turn has prompted interest in examining the potential efficacy of antiviral agents to prevent or ameliorate neurodevelopmental injury. Currently, there are three licensed systemic antivirals for the treatment of CMV: ganciclovir (Cytovene, Roche] and its prodrug valganciclovir [Valcyte, Roche); foscarnet (Foscavir, AstraZeneca); and cidofovir (Vistide, Pharmacia). A CMV-specific immunoglobulin is also available. Experience with these agents in the setting of congenital and perinatal CMV infection is very limited, but there are encouraging data from a controlled clinical trial indicating that ganciclovir therapy may be of value in limiting one form of neurodevelopmental injury caused by congenital infection, that of sensorineural hearing loss. Licensed antivirals for the treatment of CMV all share the common mechanism of targeting the viral DNA polymerase, but novel therapies that employ alternative modes of action are in development. Ultimately, the problem of perinatal CMV infection may be best controlled by the development of CMV vaccines, which could be administered to young women of childbearing age to help control this important public health problem.

Severe postnatal cytomegalovirus infection with multisystem involvement in an extremely low birth weight infant

“…Experience with these agents in the setting of congenital and postnatal CMV infection is limited. 10,11 Positive effects of ganciclovir treatment have been described in cases with postnatal infection. 4,12 Commonly reported side effects of ganciclovir include myelosuppression, technical problems with venous access and long-term side effects as gonadal toxicity.…”

“…Type specific immunoglobulin has been used for postnatal infection, but not seem to be a valuable approach. 10,13 Finally, CMV vaccines may hold the greatest promise in reducing the neurodevelopmental consequences of congenital infection, although the immune correlates of protection of the fetus incompletely defined. 14 In our patient, the clinical condition remained critical under broad-spectrum antibiotic therapy and intensive care, we opted for starting intravenous ganciclovir-based antiviral therapy.…”

Successful treatment with oral valganciclovir in immunocompetent infant with gastrointestinal manifestations of cytomegalovirus infection

“…At that time, laboratory investigations revealed hemoglobin of 8 g/dl, platelet count of 168 000/mm 3 , and leukocyte count 4500/mm 3 . Coagulation studies, renal function, transaminases, and albumin values were normal; hyperbilirubinemia was present with total serum bilirubin concentration of 9.6 mg/dl and direct bilirubin level of 1.0 mg/dl.…”

Prevalence of Human Cytomegalovirus Infection among Human Immunodeficiency Virus Positive Women Receiving Antiretroviral Treatment at Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria

“…Forscanet inhibits viral DNA polymerase by binding to the pyrophosphate binding site and preventing cleavage of pyrophosphate from the deoxynucleotide triphosphate [46]. CDV is a monophophate analog of cytosine that uses mammalian cellular kinase [47]; it acts by competitive inhibition of cytosine incorporation into the viral DNA strand inhibiting elongation of the strand. The incorporation of two (2) consecutive CDV molecules into a growing strand causes chain termination [48].…”