The spectrum of cytomegalovirus infection and its management

Serious disease due to cytomegalovirus (CMV) is almost totally confined to congenitally infected infants and the immunocompromised. Cell-mediated immunity is primarily responsible for the control of infection following primary infection and for prevention of disease after reactivation. In patients receiving active immunosuppression for transplantation, the choice of drug regimens is important in determining the likelihood of disseminated CMV infection and disease and it may be possible to control the infection by reducing the doses used. A number of strategies have been introduced in attempts to reduce the morbidity and mortality of CMV in the immunocompromised. These include prophylactic administration of specific immunoglobulin or acyclovir and the therapeutic use of several antiviral agents shown to have activity against CMV in vitro. Ganciclovir (DHPG) and foscarnet (phosphonoformate) have shown the most promise in clinical trials and ganciclovir has now been licensed for use in the UK, in sight- and life-threatening infections.