Management of cytomegalovirus infection

Cytomegalovirus (CMV) remains an important pathogen in immunocompromised hosts, though several advances in its management have been made. Primary infection can be prevented by serologic screening of blood and organ donors, and the use of leukocyte-depleted blood products deserves further study in this context. Immunoglobulin prophylaxis may be effective in reducing the severity of infection in some groups. Virus reactivation can be delayed or prevented by high-dose intravenous acyclovir, and results should be improved by use of newer agents with greater anti-CMV activity, such as ganciclovir and foscarnet. However, the bone marrow toxicity of ganciclovir may reduce its prophylactic potential. Recent results with combined antiviral chemotherapy are encouraging, and other approaches in the future will undoubtedly include use of either recombinant or subunit vaccines or adoptive immunotherapy with effector cells generated in vitro for clinical use.