Section Review: Biologicals & Immunologicals: New insights into the pathogenesis and treatment of cytomegalovirus

Abstract

There is now increasing evidence that CMV disease results not only from the cytopathogenic effects of the virus itself but also from a CMV-induced immunologic reaction. In addition, CMV can affect both haematopoietic progenitor cells and stromal cell functions, resulting in lympho- and myelosuppression. These observations emphasise the potential benefit of immunological approaches to the treatment of CMV disease. The most promising approach to the prevention of CMV disease in transplant recipients is clearly adoptive transfer of CMV specific T-cell clones from the donor. However, at present, this approach remains experimental and restricted to a small number of patients. Combination of intravenous immunoglobulin (IVIG) and ganciclovir (GCV) is currently the most successful treatment for CMV pneumonia but this approach remains unsatisfactory. It is thus of major importance to distinguish CMV infection from CMV disease in an attempt to prevent the morbidity and mortality of CMV disease by prophylactic or pre-emptive treatments. There remains an urgent need for new anti-viral agents, active both intravenously and orally, and devoid of significant haematological or renal toxicity. At present, HPMPC is the most promising new anti-CMV drug.