Treatment of cytomegalovirus infections beyond acute disease to improve human health

Abstract

Human cytomegalovirus is a common virus that establishes latency and persistence after a primary infection in 50–90% of populations worldwide. In otherwise healthy persons, the infection is generally mild or asymptomatic, although it may cause mononucleosis, prolonged episodes of fever, and hepatitis. However, in AIDS patients and transplant recipients who are immunosuppressed, severe, life-threatening infections may develop. CMV is also the most common congenital infection and may cause birth defects and deafness. Emerging evidence shows a high prevalence of this virus in patients with chronic inflammatory diseases or tumours of different origin, such as breast, colon, and prostate cancer, neuroblastoma, medulloblastoma, and glioblastoma. Several drugs are available to treat CMV infections. This review will highlight the possibility of using anti-CMV therapy to improve outcome not only in patients with acute CMV infections but also in patients with inflammatory diseases and cancer.

Keywords::

• AIDS patients
• cancer
• cidofovir
• CMV
• cytomegalovirus
• immunoglobulins
• inflammation
• maribavir
• transplant patients
• valganciclovir

Acknowledgements

The author thanks the following foundations for supporting the CMV cancer project; Sten A Olssons Foundation, IngaBritt and Arne Lundbergs Foundation, BILTEMA Foundation, Stichting af Jochnicks Foundation, Family Erling Perssons Foundation, Petrus and Augusta Hedlunds Foundation, Torsten Söderbergs Foundation, RATOS, The Swedish Cancer Foundation and the Swedish Medical Research Foundation.

Financial & competing interests disclosure

C Söderberg-Nauclér held an independent investigational grant from Hoffman La Roche from 2005–2008 to study the efficacy and safety of Valganciclovir in glioblastoma patients (VIGAS trial 2005–2008). During this time, the author also gave invited lectures on the topic ‘molecular mechanisms of indirect effects of CMV’, sometimes sponsored by the same company. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• CMV is still a cause of life-threatening infections in neonates and immunosuppressed patients.

• CMV causes immune exhaustion in the elderly, which is associated with increased mortality.

• Emerging evidences suggest that CMV may have an important role in chronic inflammation and cancer.

• Anti-CMV treatments may provide a new therapeutic strategy for patients with cancer, in the elderly and possibly certain chronic inflammatory conditions as well.

• Vaccination strategies to improve immune control of this virus should be further developed and evaluated for impact to improve health in CMV-associated pathologies.