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Antiviral therapy of CMV disease in children

Mike Sharland1, Suzanne Luck, Paul Griffiths

  • 1Paediatric Infectious Diseases Unit, St. George's Hospital, London, UK. mike.sharland@stgeorges.nhs.uk

Advances in Experimental Medicine and Biology
|December 2, 2010
PubMed

Insights

Cytomegalovirus (CMV) causes significant illness in children, especially those with congenital or acquired infections. Current antiviral treatments like ganciclovir (GCV) and valganciclovir (VGCV) lack robust evidence, necessitating further research.

Area of Science:

  • Pediatric Infectious Diseases
  • Virology
  • Pharmacology

Background:

  • Cytomegalovirus (CMV) is a significant cause of illness and death in infants and children, particularly those with congenital infections, premature infants, and immunocompromised children.
  • CMV is a critical co-pathogen in HIV-infected infants in lower-income countries.
  • Current antiviral treatment options for CMV disease in children are limited, with suboptimal evidence for established therapies.

Purpose of the Study:

  • To review the clinical spectrum of CMV disease in childhood.
  • To evaluate the evidence base for ganciclovir (GCV) and valganciclovir (VGCV) use in pediatric practice.
  • To discuss ongoing and needed antiviral studies for CMV in children.

Main Methods:

  • Literature review of current clinical practices and evidence for CMV treatment in children.
  • Analysis of existing data on ganciclovir (GCV) and valganciclovir (VGCV) efficacy and safety.
  • Identification of gaps in knowledge and future research directions.

Main Results:

  • Ganciclovir (GCV) has been used for over 20 years, but optimal dosing, duration, and administration routes are poorly defined, especially in premature infants and older children.
  • Direct comparative studies between intravenous ganciclovir and oral valganciclovir (VGCV) are lacking.
  • Cidofovir and foscarnet exhibit significant toxicities, and few other effective anti-CMV agents are in late-stage development.

Conclusions:

  • There is a critical need for improved evidence-based guidelines for CMV antiviral therapy in children.
  • Further clinical trials are required to establish optimal treatment strategies and identify surrogate markers for therapy success.
  • Development of novel, safer, and effective anti-CMV agents is essential for managing pediatric CMV disease.

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