Management of human cytomegalovirus infection in transplant recipients by the pre-emptive therapy approach

Research output: Contribution to journalArticle

Abstract

Human cytomegalovirus (HCMV) infections are still a major infectious complication in the post-transplant period of both solid organ transplant recipient (SOTRs) and hematopoietic stem cell transplant recipients (HSCTRs). For many years, the major diagnostic assay has been antigenemia, allowing semi-quantification of HCMV load in blood from transplanted patients with disseminated HCMV infection. More recently, the real-time PCR assay has replaced antigenemia for HCMV DNAemia quantification. Prevention of HCMV disease is based on either prophylaxis or pre-emptive therapy with antiviral drugs. The latter approach has been in use in our department for the last 15 years. A cut-off of 300,000 DNA copies/ml whole blood in SOTRs with either primary or reactivated infection, and a cut-off of 10,000 DNA copies/ml blood in HSCTRs proved to be safe and effective in prospective randomized, controlled trials. With this approach, HCMV disease is consistently prevented, except for a limited number of cases of organ localization in the absence of virus in blood. In these cases, HCMV infection/disease must be diagnosed by local biopsy samples.

Original languageEnglish
Pages (from-to)155-164
Number of pages10
JournalFuture Virology
Volume4
Issue number2
DOIs
Publication statusPublished - 2009

Keywords

  • HCMV
  • Hematopoietic stem cell transplant recipients
  • Pre-emptive therapy
  • Prophylaxis
  • Solid organ transplant recipients

ASJC Scopus subject areas

  • Virology

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