Cytomegalovirus (CMV) is usually an asymptomatic infection in people who contract it and have a normally functioning immune system. Symptomatic disease in these patients usually manifests as a mononucleosis syndrome and/or mild flu-like symptoms.

Clinically significant CMV disease frequently develops in patients who have a compromised or weakened immune system from HIV infection, solid-organ transplantation and bone-marrow transplantation. Symptoms in these patients can affect almost every organ of the body, resulting in fever of unknown origin, pneumonia, hepatitis, encephalitis, colitis, retinitis and neuropathy.

CMV is seldom associated with death in patients with normally functioning immune systems, but can in patients who do not have a normally functioning immune system or have undergone transplant. There are some FDA-approved medications for the treatment of CMV infection

 

Treatment Overview

The drug of choice for treatment of CMV disease, ganciclovir may be used prophylactically for patients who have a positive CMV serology and evidence of ongoing viral replication as well as those patients who require treatment for active disease process. While ganciclovir is available in an oral formulation, the intravenous formulation produces serum levels that are 5-10 times greater, thus making oral ganciclovir a less-than-optimal agent for the management of active CMV disease, but may be used for prophylaxis of CMV disease.

 

Because of the poor oral absorption of ganciclovir, the product which has an FDA-approved indication for treatment of CMV retinitis is valganciclovir. This product has a similar absorption to that of intravenous ganciclovir, making it the optimal choice for treatment in a setting outside of the hospital.

 

Foscarnet is an effective antiviral reserved for use in treating ganciclovir-resistant strains of CMV. As a second-line agent, foscarnet dosing must me adjusted according to kidney function so it is important to monitor changes in kidney function prior to initiating therapy as well as during the treatment cycle.

 

Cidofovir is an anti-viral medication reserved for the treatment of refractory CMV retinitis in patient positive for HIV infection. The most common toxicity is kidney-related and must be administered with probenecid to protect the kidney from damage.