Human cytomegalovirus: challenges, opportunities and new drug development

In the age of highly active antiretroviral therapy, the incidence of human cytomegalovirus (HCMV) retinitis in AIDS patients has decreased substantially. However, this change does not indicate that HCMV disease in AIDS patients and other immunocompromised patients has abated and is no longer a concern. On the contrary, HCMV disease in graft recipients, newborns, and even in AIDS patients still accounts for considerable morbidity, and drug resistance to the anti-HCMV compounds is a major problem. Furthermore, HCMV may have a role in metabolic diseases, such as atherosclerosis. Fortunately there are novel and potentially very effective new compounds undergoing pre-clinical and clinical evaluation. These developments point the way toward new therapies and also to a clearer understanding of the biology of HCMV replication, infection and disease.