CMV in immunocompromised host
Treatment:
The objective of treatment is to stop the replication of
the virus within the body through the use of antiviral agents.
These agents DO NOT eliminate the virus from the body; they
only keep it from dividing. The most commonly used agents
are ganciclovir, foscarnet, and cidofovir. These are used
in patients in whom CMV disease is established throughout
the body.
For CMV infection of the eye, the agent valacylcovir has
been shown to suppress progression of CMV retinitis in HIV
patients. A new agent named Fomivirsen has recently been approved
by the FDA, and works via direct injection of the drug into
the eye.
Foscarnet and cidofovir are associated with significant nephrotoxicity
(kidney damage) and electrolyte abnormalities, which may require
supplementation by intravenous electrolytes. Ganciclovir can
cause neutropenia (severe depletion of white blood cells).
There is evidence that resistance to some of these agents
exists, especially to ganciclovir. Newer medications to fight
CMV are in development.
Expectations (prognosis):
CMV infection in the immunocompromised host can be life threatening
and the severity of the disease is dependent on the strength
of the individual's immune system. Individuals who have undergone
bone marrow transplant have been shown to have the highest
mortality risk. Any immunocompromised person, whether an HIV
patient, organ transplant recipient, bone marrow transplant
recipient or medically immunosuppressed
individual, should seek out medical advice if any signs of
infection should occur.
Frequently Asked Questions (FAQ)
Who should be tested for CMV?
Anyone who has symptoms of infectious mononucleosis but has
negative test results for mononucleosis and Epstein Barr virus,
or shows signs of hepatitis, but has negative test results
for hepatitis A, B, and C.
Should I get my children tested for CMV?
There is no need to either screen for CMV or exclude CMV-excreting
children from schools or institutions because the virus is
frequently found in many healthy children and adults.
Calling your health care provider:
Call your health care provider if symptoms of CMV infections
occur and you are an immunosuppressed
person.
Update Date: 04/01/00
Updated By: Luis A. Diaz, Jr. M.D., Johns Hopkins Medical Institute, VeriMed
Health Network
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