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Antiviral combination therapy for cytomegalovirus infection in high-risk infants

Surabhi B Vora1,2, Adam W Brothers3, Alpana Waghmare1,2,4

  • 1Division of Infectious Diseases, Department of Pediatrics, University of Washington, Seattle, WA, USA.

Antiviral Therapy
|May 24, 2018
PubMed

Insights

Initial combination therapy with ganciclovir (GCV) and foscarnet (FOS) shows promise for treating Cytomegalovirus (CMV) infection in high-risk infants with immune defects. This approach may be a safe alternative to monotherapy, with no significant resistance mutations observed.

Area of Science:

  • Pediatric Infectious Diseases
  • Virology
  • Immunology

Background:

  • Cytomegalovirus (CMV) infection poses a significant mortality risk in infants with severe combined immunodeficiency (SCID) and other profound immune defects.
  • Early and aggressive antiviral therapy is crucial due to potential resistance, rapid spread, and poor transplant outcomes.
  • The efficacy of combination antiviral therapy for CMV remains unclear.

Purpose of the Study:

  • To explore the strategy of initial combination antiviral therapy for high-risk infants diagnosed with CMV infection.
  • To evaluate the safety and efficacy of combined ganciclovir (GCV) and foscarnet (FOS) therapy compared to monotherapy.

Main Methods:

  • A retrospective review of medical records for infants ≤6 months old hospitalized between 2007-2015.
  • Patients received either ganciclovir (GCV) or foscarnet (FOS) monotherapy or initial combination GCV + FOS for CMV disease.
  • The study focused on severely immunocompromised infants considered for hematopoietic cell transplantation (HCT).

Main Results:

  • Four patients received initial combination therapy; 26 received monotherapy.
  • Combination therapy recipients showed initial improvement in viraemia; two of three who continued the therapy survived.
  • No clinically significant resistance mutations emerged. Common toxicities included neutropenia, thrombocytopenia, and electrolyte abnormalities; creatinine elevation was infrequent.

Conclusions:

  • Combination GCV + FOS therapy may be a safe alternative to monotherapy in high-risk infants.
  • This approach is particularly relevant for pre-transplant infants with primary immune deficiencies and high viral loads.
  • Further research is warranted to establish the definitive role of combination therapy in CMV treatment.
Abstract

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