Medication
Medical Care. The drug of choice for prevention of cytomegalovirus (CMV) disease in solid-organ transplant patients is now valganciclovir.Other than CMV retinitis, however, ganciclovir remains the mainstay of treatment, at least initially.
Nutrition
As with any patient, attention must be focused on avoiding iatrogenic infections and problems. Patients who develop CMV disease are immunocompromised, meaning that they at greater risk for bacterial and fungal infections. If possible, the patient's level of immunosuppression should be lowered.
What is the drug of choice for cytomegalovirus (CMV)?
Cytomegalovirus (pronounced si-to-MEG-a-lo-vi-rus), or CMV, is a virus that belongs to the Herpesviridae family, hence its older name, "human herpes virus 5 (HHV 5)".
What should be included in patient education about cytomegalovirus (CMV) disease?
Young, healthy adults usually do not need to be tested because they do not need to be treated specifically for CMV. They usually recover over a period of weeks.
What is cytomegalovirus?
Should I get tested for cytomegalovirus?
Which of the following drugs has the best activity against CMV?
Cidofovir (Vistide®) is a broad spectrum antiviral drug with potent activity against CMV and herpes virus infections both in vitro and in vivo [33-36].
Can CMV be treated with antibiotics?
For otherwise healthy people, CMV usually doesn't require treatment. If your immune system is weakened, your doctor may use a medicine to treat CMV. However, because CMV is a virus, regular antibiotics won't work. Antiviral drugs are usually prescribed.
What drug is used to treat cytomegalovirus CMV an inflammation of the retina that is caused by a virus?
Drugs for CMV Retinitis. The anti-viral drugs commonly used to treat CMV retinitis are ganciclovir (Cytovene), foscarnet (Foscavir) and cidofovir (Vistide). They can slow down the progression of CMV, but they can't cure it. Like many drugs, these treatments can cause unpleasant or serious side effects.
Can you treat CMV with acyclovir?
At present, there is no effective therapy for human cytomegalovirus (CMV) infections. Although acyclovir inhibits in vitro clinical isolates of CMV, preliminary human trials suggest that acyclovir may not be successful as a single antiviral agent in treating CMV infections.
What medications treat CMV?
The drug of choice for treatment of CMV disease is intravenous ganciclovir, although valganciclovir may be used for nonsevere CMV treatment in selected cases. Ganciclovir is a nucleoside analogue that inhibits DNA synthesis in the same manner as acyclovir.
When do you treat CMV?
Medications are available to treat CMV infection in people who have weakened immune systems and babies with signs of congenital CMV. For babies with signs of congenital CMV infection at birth, antiviral medications, primarily valganciclovir, may improve hearing and developmental outcomes.
What is foscarnet used to treat?
Foscarnet is principally used for the treatment of ganciclovir-resistant cytomegalovirus (CMV) infections in patients with the acquired immunodeficiency syndrome (AIDS) or in transplant recipients.
What is cytomegalovirus CMV infection?
Cytomegalovirus infection is a common herpesvirus infection with a wide range of symptoms: from no symptoms to fever and fatigue (resembling infectious mononucleosis) to severe symptoms involving the eyes, brain, or other internal organs. This virus. It requires a living cell in which to multiply.
What kills CMV virus?
Currently, intravenous ganciclovir or oral valganciclovir are the primary antiviral treatments for CMV. The drugs suppress the virus, says Boger, but they can't eliminate it. In the absence of vaccine for CMV, the best form of prevention is hand-washing.
Which of the following vaccine used for the treatment of cytomegalovirus?
A recombinant HCMV glycoprotein B (gB) vaccine has been shown to have some efficacy in prevention of infection in young women and adolescents, and provided benefit to HCMV-seronegative SOT recipients.
What type of drug is ganciclovir?
Ganciclovir is an antiviral. It is used to treat infections caused by viruses. Ganciclovir is used to treat the symptoms of cytomegalovirus (CMV) infection of the eyes in people whose immune system is not working fully. This includes patients with acquired immune deficiency syndrome (AIDS).
Does valacyclovir treat CMV?
Valacyclovir has been used for prophylaxis against cytomegalovirus (CMV) infection after hematopoietic stem cell transplantation (HSCT).
What is the most recent anti-CMV drug?
Letermovir (Prevymis) is the most recently approved anti-CMV medication (FDA approval granted in November 2017, and EMA marketing authorisation in January 2018). Letermovir inhibits the viral terminase complex (which consists of the CMV-encoded proteins pUL51, pUL56, and pUL89), which is a DNA packaging unit that is essential for DNA-containing viral capsid formation. By inhibiting terminase activity (by binding to pUL51 and/or pUL56), letermovir prevents CMV replication. This drug can be administerd orally or by i.v. infusion. It is approved as prophylaxis for CMV in allogeneic hematopoietic-cell transplantation patients who are receiving immunosuppressant therapy. It prevents CMV reactivation in these patients (see PMID: 29211658 ).
What is GCV used for?
GCV is more commonly used to treat CMV retinitis, usually in patients who have suppressed immune systems ( e.g. AIDS patients and solid organ transplant patients). It is also used to treat ocular ulcers caused by the herpes simplex virus.
Is GCV a nucleoside analogue?
pUL54 inhibitors. Ganciclovir (GCV; Cytovene) is a nucleoside analogue. It must be phosphorylated (to the nucleotide) by the viral protein kinase, pUL97 to confer anti-viral activity. Use of GCV as prophylaxis for CMV is limited by clinically significant myelosuppression.
What is the treatment for CMV?
There are various CMV-treatment approaches based on patient’s CMV-status and co-morbidities. Some patients receive prophylaxis while some receive preemptive therapy. Prophylaxis is given to a patient to prevent primary, reactivation or recurrent infection. Preemptive therapy is given to an asymptomatic CMV-infected patients with CMV detected by screening tests. Some studies have shown that high-dose acyclovir or valacyclovir prophylaxis markedly reduces CMV infection in allo-HSCT recipients. Intravenous ganciclovir has been also tested, with some reduction in CMV infection, however this did not provide overall survival benefit and was also associated with bone marrow suppression (ganciclovir-induced neutropenia). [ 43]
What is the drug that inhibits the CMV DNA terminase complex?
Letermovir is an anti-CMV drug that was approved by the FDA in November 2017. It inhibits the CMV DNA terminase complex (pUL51, pUL56, and pUL89), which is required for viral DNA processing and packaging by affecting the production of proper unit length genomes and interfering with virion maturation.
What is Valganciclovir used for?
Valganciclovir is used for treatment in selected CMV cases. [ 68] . Most experience has been established in renal and pancreas transplant recipients and patients with AIDS who have CMV retinitis. It is also the drug of choice now for preemptive or universal CMV prophylaxis. [ 2] .
How long does ganciclovir last?
The length of treatment varies. Some clinicians have administered ganciclovir for as long as 2-4 weeks from the end of the induction period, depending on the clinical status of the patient.
What is letermovir used for?
Letermovir, a CMV terminase inhibitor, has been used for primary prevention of CMV in sero-positive allo-HSCT recipients. Some studies such as Marty et al, have demonstrated efficacy of it’s use, with a 23.5% reduction of CMV infection at week 24 after transplantation.
How many CMV shots were given to women?
Three doses of the CMV vaccine or placebo were administered at 0, 1, and 6 months to 464 CMV-seronegative women within 1 year after they had given birth. After a minimum follow-up period of 1 year, 49 confirmed CMV infections were reported—18 in the vaccine group and 31 in the placebo group.
Is Valganciclovir a prodrug?
Valganciclovir. Valganciclovir is a prodrug of ganciclovir that is activated in the gut and liver to ganciclovir. Valganciclovir has 60% bioavailability. Valganciclovir 900 mg orally once daily is equivalent to once-daily intravenous ganciclovir 5 mg/kg.
What is the CMV?
Cytomegalovirus (CMV) infection facts. CMV is a common virus in the same family as herpesvirus, and it can infect anyone. CMV spreads by direct contact of body fluids, such as saliva, blood, urine, semen, vaginal fluids, congenital infection, and breast milk.
What is the best antiviral for CMV?
Ganciclovir ( Cytovene) is the first antiviral medication approved for the treatment of CMV infection. Ganciclovir, given intravenously, is the drug of choice for the treatment of CMV infection. Side effects include fever, rash, diarrhea, anemia, and low white blood cell and platelet counts.
What is the most common type of CMV disease in people with HIV/AIDS?
One of the most common types of CMV disease in people with advanced HIV/AIDS is CMV retinitis, which may cause permanent blindness.
How does CMV spread?
CMV spreads by direct contact of body fluids, such as saliva, blood, urine, semen, vaginal fluids, congenital infection, and breast milk. Thus, breastfeeding, blood transfusions, organ transplants, maternal infection, and sexual contact are possible modes of transmission. Most healthy people do not experience any symptoms when infected with CMV, ...
Why is CMV used in AIDS?
Its use is limited due to toxicity to the kidneys. It is used mainly for the treatment of CMV infection of the eye (retinitis) in patients with acquired immune deficiency syndrome ( AIDS) caused by the human immunodeficiency virus (HIV). CMV immune globulin contains antibodies (proteins) that are specific to CMV.
How many women get CMV during pregnancy?
Only about 1%-7% women are infected for the first time with CMV (primary CMV) during pregnancy, but 30%-40% of those will pass it on to the baby (congenital CMV). Congenital cytomegalovirus infection causes more complications the earlier in pregnancy that the virus is passed from the mother.
How many people have CMV?
Experts estimate that more than half of the adult population in the United States has been infected with CMV, and 80% of adults have had the infection by the time they are 40 years old. About one in 150 children is born with CMV infection (congenital cytomegalovirus).
What is the CMV?
Cytomegalovirus (CMV) is a virus related to the herpes virus. It is so common that almost all adults in developing countries and 50% to 85% of adults in the United States have been infected. Usually CMV is a mild disease that does not cause any serious problems in healthy children and adults.
What is needed for CMV?
For people with HIV/AIDS who have a severely weakened immune system, or for people who have had an organ or bone marrow transplant, the diagnosis of CMV usually requires a detailed physical exam and blood tests.
How many babies are infected with CMV?
There are three classes of CMV infection, each with different symptoms: Congenital. Up to 40% of babies born to women who are newly infected with CMV during pregnancy will become infected. Not all infected babies will have symptoms at birth.
How do you know if you have CMV?
In most cases, healthy people who become infected with CMV usually develop minor symptoms or no symptoms at all. When symptoms occur, they are similar to the symptoms of mononucleosis: Fatigue. Low-grade fever (can last days or weeks) Chills and/or sweats. Muscle aches .
What are the symptoms of CMV?
Symptoms can include painful and difficult swallowing, nausea, vomiting, abdominal pain, yellow skin and watery or bloody diarrhea. CMV can infect the brain and other parts of the nervous system, causing symptoms like headache, confusion, and leg weakness.
What is the most serious disability caused by CMV?
This type of CMV infection causes as much serious disability as Down syndrome, fetal alcohol syndrome and neural tube defects. Newborns with CMV are likely to be born premature and at a low birth weight.
How long does it take for a baby to recover from CMV?
The diagnosis needs to be confirmed by testing blood or tissue from the infant within three weeks of birth. Young, healthy adults usually do not need to be tested because they do not need to be treated specifically for CMV. They usually recover over a period of weeks.
What tests can detect CMV?
Diagnosis. Laboratory tests — including tests of blood and other body fluids or tests of tissue samples — can detect CMV.
Why is CMV testing important?
Testing for CMV can also be important if you have a weakened immune system. For example, if you have HIV or AIDS, or if you've had a transplant, your doctor may want to monitor you regularly.
Can you get CMV without medication?
Treatment generally isn't necessary for healthy children and adults. Healthy adults who develop CMV mononucleosis generally recover without medication. Newborns and people who have weakened immunity need treatment when they're experiencing symptoms of CMV infection.
Can a CMV infection be detected while pregnant?
Pregnant women who have already developed CMV antibodies have a very small chance of a reactivation infecting their unborn children. If your doctor detects a new CMV infection while you're pregnant, a prenatal test (amniocentesis) can determine whether the fetus has been infected.
What is the medical name for CMV?
Medications for CMV Infection. Other names: CMV, congenital; Congenital Cytomegalovirus; Cytomegalovirus Infection. Cytomegalovirus is a common virus with over half of the population in the United States, under the age of 50 years old, being infected. Once a person has had CMV the virus stays in the body as a dormant or inactive infection ...
How does CMV stay in your body?
Once a person has had CMV the virus stays in the body as a dormant or inactive infection and is usually kept in check by the immune system. If the immune system is lowered or compromised the infection can be reactivated and is able to spread.
How does CMV spread?
The CMV virus can be spread from an infected person to others if there is contact with their body fluids including urine, saliva, tears, breast milk, blood or semen. Transmission of the infection can occur through blood or organ transplants from an infected person. Congenital CMV is when the CMV infection is passed from a mother to her baby ...
What is congenital CMV?
Congenital CMV is when the CMV infection is passed from a mother to her baby during pregnancy. This can happen if the mother has her first infection while pregnant or she has a reactivation of an earlier infection.
Can you get CMV from a low immune system?
Most people who have had CMV have no serious health problems, however if a patient has a low immune system or a baby is infected by the mother during pregnancy (congenital CMV) there is a risk for more serious complications.
What Is Cytomegalovirus (CMV)?
Symptoms
Diagnosis
Expected Duration
Specialist to consult
Prevention
- Cytomegalovirus (CMV) is a virus related to the herpes virus. It is so common that almost all adults in developing countries and 50% to 85% of adults in the United States have been infected. Usually CMV is a mild disease that does not cause any serious problems in healthy children and adults. Most people get flu-like symptoms or an illness similar ...
Treatment
- There are three classes of CMV infection, each with different symptoms: Congenital Up to 40% of babies born to women who are newly infected with CMV during pregnancy will become infected. Not all infected babies will have symptoms at birth. This type of CMV infection causes as much serious disability as Down syndrome, fetal alcohol syndrome and neural tube defects. Newborn…
When to Call A Professional
- Doctors may order blood tests for babies with low birth weight, jaundice, small brains or other problems that can be associated with congenital CMV, but can also be caused by other things. The diagnosis needs to be confirmed by testing blood or tissue from the infant within three weeks of birth. Young, healthy adults usually do not need to be tested because they do not need to be tr…
Prognosis
- Disease progression in babies who are infected in the womb, during birth or through breastfeeding may vary a great deal. Some babies may die from the infection and some may have no long-lasting effects at all. Prognosis depends on many factors and these babies should be seen by a specialist. Adults with a healthy immune system who are already infected with CMV can expect …
Further Information
- Pregnant women who care for young children should: 1. Wash their hands often with soap and water, especially after changing diapers. Wash well for 15 to 20 seconds. 2. Not kiss young children under the age of 5 or 6 on the mouth or cheek. Instead, kiss them on the head or give them a big hug. 3. Not share food, drinks or utensils (spoons or forks) with young children. If yo…