Squifflet Jean-Paul, Legendre Christophe
University Clinic Saint Luc, 1200 Brussels, Belgium.
J Infect Dis. 2002 Oct 15;186 Suppl 1:S116-22. doi: 10.1086/342961.
Cytomegalovirus (CMV) infection and disease, with its extensive direct and indirect consequences, adds considerably to the cost of patient management in both solid organ and bone marrow transplantation. Antiviral prophylaxis for CMV infection can offer cost advantages over preemptive therapy and "wait-and-treat" approaches. Valacyclovir has demonstrated efficacy for CMV prophylaxis in renal, heart, and bone marrow transplantation and is cost-effective when compared with placebo in renal transplant recipients at high risk of CMV infection. In reducing CMV infection and disease, valacyclovir prophylaxis appears to be associated with reductions in indirect effects of CMV (acute graft rejection, other opportunistic infections) and, if these effects are considered, the potential exists for even greater savings to be made with valacyclovir therapy. Benefits of valacyclovir in transplantation extend beyond CMV to other herpesviruses and may be increased in some clinical situations by prolonging prophylaxis beyond 3 months.
巨细胞病毒（CMV）感染及相关疾病会产生广泛的直接和间接后果，这显著增加了实体器官移植和骨髓移植患者的管理成本。针对CMV感染的抗病毒预防措施相对于抢先治疗和“观察等待”方法具有成本优势。伐昔洛韦已在肾移植、心脏移植和骨髓移植中证明对CMV预防有效，并且与CMV感染高风险的肾移植受者使用安慰剂相比具有成本效益。在降低CMV感染及相关疾病方面，伐昔洛韦预防似乎与CMV的间接影响（急性移植物排斥、其他机会性感染）的减少有关，如果考虑这些影响，伐昔洛韦治疗有可能实现更大的成本节约。伐昔洛韦在移植中的益处不仅限于CMV，还扩展到其他疱疹病毒，并且在某些临床情况下，将预防时间延长至3个月以上可能会增加其益处。
