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Understanding Viral Load Assays for Cytomegalovirus and Epstein-Barr Virus



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CMV Treatment Strategies

Slide 6

March 2010

For patients at risk of infection, there are 2 main strategies to prevent CMV disease.

The first is prophylactic. In this strategy, high-risk patients are given treatment during the period of time in which they are thought to be most at risk for disease. The treatment is given regardless of symptoms, and is intended to prevent primary infection or reactivation. The advantage is that the patient is being continuously protected from CMV infections, but the disadvantage is that the drugs can be costly and are not without drug-drug interactions and side effects, not to mention the increased potential for antiviral resistance.

The second strategy is preemptive. For some low-risk or moderate-risk patients, this might be the preferred strategy. Viral loads are monitored periodically, typically weekly. Therapy is then administered when CMV is first detected, regardless of whether symptoms are evident. The advantage here is that only infections are being treated, which reduces drug complications and reduces the potential for antiviral resistance. The disadvantage is that the viral load tests are not without cost, and the therapy may not begin as soon as needed.

Treatment for CMV in transplant populations is typically ganciclovir, though a reduction in immunosuppression may also be considered.

Treatment Strategies

 


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