Strategies for the treatment and prevention of cytomegalovirus infections.

Currently, only two drugs, i.e. ganciclovir, (DHPG, cytovene)_and foscarent (PFA, Foscavir), are licenced for the treatment of severe CMV infections. Both compounds may have serious side effects and can lead to the emergence of drug-resistant virus strains. Recent pertain to the efficacy of prophylactic or pre-emptive therapy with ganciclovir to prevent the development of CMV infections in transplant recipients. The search for safe and effective anti-CMV chemotherapeutics recently led to the development of some new promising anti-CMV compounds (HPMPC, cyclobutylguanine, benzimidazoles), of which HPMPC is currently undergoing clinical evaluation. Intravenous hyperimmune and normal gamma-globulin have been used prophylactically or therapeutically in the treatment of CMV disease. Some of the trials indicate that immunoglobulin prophylaxis might reduce the incidence or severity of CMV infections in transplant recipients. Some studies also claim prophylactic efficacy for acyclovir, whereas other conclude that acyclovir has little, if any, prophylactica activity in the prevention of CMV infections. The use of live attenuated or subunit CMV vaccines for the prevention of primary CMV infections in solid organ transplant recipients and pregnant women deserves further consideration. Another promising, recently reported, approach is the adoptive transfer of CMV-specific cytotoxic T-cells to the immuno suppressed host with the goal of conferring an adapted immune response.