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[cytomegalovirus; resistance; antiviral therapy; UL97 kinase; polymerase]

Sophie Alain1, Sébastien Cotin1, Sébastien Hantz1

  • 1Service de bactériologievirologie-hygiène, CHU de Limoges, Centre national de référence des cytomégalovirus, EA3175, Faculté de médecine de Limoges.

Virologie (Montrouge, France)
|September 24, 2022
PubMed

Insights

Antiviral resistance in cytomegalovirus (CMV) is a significant issue for transplant patients. Genotyping and phenotyping are crucial for managing CMV infection when resistance emerges.

Area of Science:

  • Virology
  • Infectious Diseases
  • Transplantation Immunology

Context:

  • Antiviral resistance in cytomegalovirus (CMV) is a growing clinical challenge, particularly in transplant recipients.
  • This resistance stems from the extensive use of approved antiviral drugs targeting the viral polymerase UL54, including ganciclovir, cidofovir, and foscarnet.
  • Resistance can arise from mutations in the UL97 kinase or the UL54 viral polymerase, impacting treatment efficacy.

Purpose:

  • To highlight the increasing problem of antiviral resistance in cytomegalovirus (CMV) within the transplant population.
  • To explain the mechanisms of resistance, including mutations in UL97 kinase and UL54 viral polymerase.
  • To emphasize the importance of resistance screening through genotyping and phenotyping.

Summary:

  • Cytomegalovirus (CMV) antiviral resistance affects up to 5% of transplant patients due to prolonged use of ganciclovir, cidofovir, and foscarnet.
  • Mutations in UL97 kinase lead to early ganciclovir resistance, while UL54 polymerase mutations confer broader resistance to antivirals.
  • Resistance screening involves genotyping clinical samples and phenotyping viral isolates to assess viral fitness and guide therapeutic decisions.

Impact:

  • Effective management of CMV infection in transplant patients requires integrated strategies including resistance screening.
  • Genotypic and phenotypic data are essential for tailoring antiviral regimens and optimizing patient outcomes.
  • Monitoring drug resistance is critical for developing new antiviral therapies and improving long-term survival in immunocompromised individuals.
Keywords:
UL97 kinaseantiviral therapycytomegaloviruspolymeraseresistance

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