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Cytomegalovirus infection - Treatment
Last reviewed: 06.07.2025
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Drug treatment of cytomegalovirus infection
Treatment of cytomegalovirus infection is carried out with drugs whose effectiveness has been proven by controlled studies: ganciclovir, valganciclovir, foscarnet sodium, cidofovir. Interferon drugs and immunomodulators are not effective in cytomegalovirus infection. In case of active cytomegalovirus infection (the presence of cytomegalovirus DNA in the blood) in pregnant women, the drug of choice is human anti-cytomegalovirus immunoglobulin (neocytotect). To prevent vertical infection of the fetus with the virus, the drug is prescribed at 1 ml/kg per day intravenously by drip 3 times with an interval of 1-2 weeks. In order to prevent the manifestation of the disease in newborns with active cytomegalovirus infection or in the manifest form of the disease with minor clinical manifestations, neocytotect is indicated at 2-4 ml/kg per day 6 times (every 1 or 2 days). If children have other infectious complications in addition to cytomegalovirus infection, instead of neocytotec, pentaglobin can be used at 5 ml/kg daily for 3 days with a repeat course if necessary, or other immunoglobulins for intravenous administration. The use of neocytotec as monotherapy in patients suffering from manifest, life-threatening or severe consequences of cytomegalovirus infection is not indicated.
Ganciclovir and valganciclovir are the drugs of choice for the treatment, secondary prophylaxis and prevention of manifest cytomegalovirus infection. Treatment of manifest cytomegalovirus infection with ganciclovir is carried out according to the scheme: 5 mg/kg intravenously 2 times a day at 12-hour intervals for 14-21 days in patients with retinitis: 3-4 weeks - for lung or gastrointestinal tract lesions; 6 weeks or more - for CNS pathology. Valganciclovir is used orally in a therapeutic dose of 900 mg 2 times a day for the treatment of retinitis, pneumonia, esophagitis, enterocolitis of cytomegalovirus etiology. The duration of administration and the effectiveness of valganciclovir are identical to parenteral therapy with ganciclovir. The criteria for the effectiveness of therapy are the normalization of the patient's condition, clear positive dynamics according to the results of instrumental studies, the disappearance of cytomegalovirus DNA from the blood. The effectiveness of ganciclovir in patients with cytomegalovirus lesions of the brain and spinal cord is lower, primarily due to the late etiologic diagnosis and untimely initiation of therapy, when irreversible changes in the central nervous system are already present. The effectiveness of ganciclovir, the frequency and severity of side effects in the treatment of children suffering from cytomegalovirus disease are comparable to those for adult patients. If a child develops life-threatening manifest cytomegalovirus infection, ganciclovir is necessary. For the treatment of children with manifest neonatal cytomegalovirus infection, ganciclovir is prescribed at a dose of 6 mg / kg intravenously every 12 hours for 2 weeks, then, if there is an initial effect of therapy, the drug is used at a dose of 10 mg / kg every other day for 3 months.
If the immunodeficiency state persists, relapses of cytomegalovirus disease are inevitable. HIV-infected patients who have undergone treatment for cytomegalovirus infection are prescribed maintenance therapy (900 mg/day) or ganciclovir (5 mg/kg per day) to prevent relapse of the disease. Maintenance therapy in HIV-infected patients who have had cytomegalovirus retinitis is carried out against the background of HAART until the CD4 lymphocyte count increases to more than 100 cells in 1 μl, which persists for at least 3 months. The duration of the maintenance course for other clinical forms of cytomegalovirus infection should be at least one month. In case of relapse of the disease, a repeated therapeutic course is prescribed. Treatment of uveitis that develops during restoration of the immune system involves systemic or periocular administration of steroids.
Currently, a strategy of "preemptive" etiotropic treatment is recommended for patients with active cytomegalovirus infection to prevent disease manifestation. The criteria for prescribing preventive therapy are the presence of deep immunosuppression in patients (in HIV infection - the number of CD4 lymphocytes in the blood is less than 50 cells in 1 μl) and the determination of cytomegalovirus DNA in whole blood at a concentration of more than 2.0 lgl0 gen/ml or the detection of cytomegalovirus DNA in plasma. The drug of choice for the prevention of manifest cytomegalovirus infection is valganciclovir, used at a dose of 900 mg / day. The duration of the course is at least a month. The criterion for stopping therapy is the disappearance of cytomegalovirus DNA from the blood. In organ recipients, preventive therapy is carried out for several months after transplantation. Side effects of ganciclovir or valganciclovir: neutropenia, thrombocytopenia, anemia, increased serum creatinine levels, skin rash, itching, dyspeptic symptoms, reactive pancreatitis.
Standard of treatment for cytomegalovirus infection
Treatment course: ganciclovir 5 mg/kg 2 times a day or valganciclovir 900 mg 2 times a day, the duration of therapy is 14-21 days or more until the symptoms of the disease and cytomegalovirus DNA disappear from the blood. In case of relapse of the disease, a repeated treatment course is carried out.
Maintenance treatment of cytomegalovirus infection: valganciclovir 900 mg/day for at least a month.
Preventive treatment of cytomegalovirus infection in immunosuppressed patients to prevent the development of cytomegalovirus disease: valganciclovir 900 mg/day for at least a month until the absence of cytomegalovirus DNA in the blood.
Preventive treatment of cytomegalovirus infection during pregnancy to prevent vertical infection of the fetus: neocytotect 1 ml/kg per day intravenously 3 times with an interval of 2-3 weeks.
Preventive treatment of cytomegalovirus infection in newborns and young children to prevent the development of the manifest form of the disease: neocytotect 2-4 ml/kg per day intravenously 6 administrations under the control of the presence of cytomegalovirus DNA in the blood.
Regime and diet
There is no special regimen or diet required for patients with cytomegalovirus infection; restrictions are set based on the patient’s condition and the location of the lesion.
Approximate periods of incapacity for work
The ability to work of patients with cytomegalovirus disease is impaired for at least 30 days.
Clinical examination
During pregnancy, women undergo laboratory testing to exclude active cytomegalovirus infection. Young children infected with cytomegalovirus infection antenatally are observed by a neurologist, otolaryngologist and ophthalmologist. Children who have had clinically expressed congenital cytomegalovirus infection are registered with a neurologist. Patients after bone marrow transplantation, other organs in the first year after transplantation should be tested for the presence of cytomegalovirus DNA in whole blood at least once a month. Patients with HIV infection with a CD4 lymphocyte count of less than 100 cells in 1 μl should be examined by an ophthalmologist and tested for the quantitative content of cytomegalovirus DNA in blood cells at least once every 3 months.
Following recommendations, using modern diagnostic methods and applying effective therapeutic agents allows preventing the development of manifest cytomegalovirus infection or minimizing its consequences.
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Prevention of cytomegalovirus infection
Prevention of cytomegalovirus infection should be differentiated depending on the risk group. It is necessary to counsel pregnant women (especially seronegative ones) on the problem of cytomegalovirus infection and recommendations on the use of barrier contraceptives during sexual intercourse, compliance with personal hygiene rules when caring for young children. It is advisable to temporarily transfer pregnant seronegative women working in children's homes, children's inpatient departments and nursery-type institutions to work that is not associated with the risk of their infection with cytomegalovirus. An important measure for the prevention of cytomegalovirus infection in transplantology is the selection of a seronegative donor if the recipient is seronegative. There is currently no patented anti-cytomegalovirus vaccine.