This article is a U.S. Government work and is in the public domain in the U.S.A.
Antiviral drugs for cytomegalovirus in transplant recipients: advantages of preemptive therapy†
Article first published online: 31 JUL 2006
This article is a U.S. Government work and is in the public domain in the U.S.A. Published in 2006 by John Wiley & Sons, Ltd.
Reviews in Medical Virology
Volume 16, Issue 5, pages 281–287, September/October 2006
How to Cite
Singh, N. (2006), Antiviral drugs for cytomegalovirus in transplant recipients: advantages of preemptive therapy. Rev. Med. Virol., 16: 281–287. doi: 10.1002/rmv.513
- Issue published online: 25 AUG 2006
- Article first published online: 31 JUL 2006
- Manuscript Accepted: 28 MAR 2006
- Manuscript Revised: 27 MAR 2006
- Manuscript Received: 22 FEB 2006
Currently available, potent antiviral agents have proven highly effective for the prevention of CMV disease during the time that prophylaxis is employed. However, late-onset CMV disease, occurring in 5–18% of the patients, has emerged as a significant complication in organ transplant recipients receiving prophylaxis. Complete suppression of the virus with long-term use of a potent antiviral agent may be less conducive to antigen-induced priming of host responses, which may explain why there is a greater likelihood of late-onset CMV disease. On the other hand, allowing controlled low-level viral replication, implicit in the strategy of preemptive therapy, may facilitate CMV-specific immune reconstitution and have a mitigating effect on the risk of late-onset CMV disease. Preemptive therapy with valganciclovir appears less likely to be associated with CMV disease, largely due to a lower incidence of late-onset CMV disease. Emerging data, documenting that CMV disease in the era of prophylaxis with potent antiviral agents is an independent contributor to mortality, particularly infection-associated mortality, stands to challenge the notion that prophylaxis is more likely to have a beneficial effect on CMV-related secondary outcomes. Preemptive therapy is a more logical and theoretically more appealing approach for the prevention of CMV disease in transplant recipients. Published in 2006 by John Wiley & Sons, Ltd.