Baillie G Mark
Medical University of South Carolina (MUSC), Charleston, SC 29425, USA.
Am J Health Syst Pharm. 2006 Oct 1;63(19 Suppl 5):S10-6. doi: 10.2146/ajhp060378.
The advantages and disadvantages of universal prophylaxis and preemptive therapy and current evidence-based recommendations for preventing cytomegalovirus (CMV) disease in solid organ transplant recipients are discussed.
Advantages of universal prophylaxis include the ease of implementation, a reduced incidence of CMV disease, and possibly fewer indirect effects of CMV infection. Disadvantages of universal prophylaxis may include prolonged antiviral drug exposure, resistance, toxicity, the development of late-onset CMV disease, and greater drug costs. Advantages of preemptive therapy may include reduced drug exposure and decreased risk for toxicity and resistance. Disadvantages include the logistic demands of laboratory testing, uncertainty about the impact on the indirect effects of CMV disease, and the costs associated with failure to prevent CMV disease. Evidence-based guidelines call for universal prophylaxis for patients at highest risk for CMV disease. Preemptive therapy may be most appropriate for those at a moderate or low risk of CMV. Antiviral drug regimens used for universal prophylaxis depend on the type of organ transplanted and the donor-recipient CMV serostatus. The optimal preemptive drug regimen and laboratory monitoring strategy are unknown.
Selection of a strategy for preventing CMV disease in solid organ transplant patients requires consideration of patient-specific risk factors as well as practical considerations, such as available resources.
讨论实体器官移植受者中普遍预防和抢先治疗预防巨细胞病毒（CMV）疾病的优缺点以及当前基于证据的建议。
普遍预防的优点包括易于实施、CMV疾病发病率降低以及CMV感染的间接影响可能减少。普遍预防的缺点可能包括抗病毒药物暴露时间延长、耐药性、毒性、迟发性CMV疾病的发生以及更高的药物成本。抢先治疗的优点可能包括药物暴露减少以及毒性和耐药风险降低。缺点包括实验室检测的后勤需求、对CMV疾病间接影响的影响不确定以及预防CMV疾病失败的相关成本。基于证据的指南要求对CMV疾病高危患者进行普遍预防。抢先治疗可能最适合CMV中低风险患者。用于普遍预防的抗病毒药物方案取决于移植器官的类型和供受者CMV血清学状态。最佳的抢先药物方案和实验室监测策略尚不清楚。
选择实体器官移植患者预防CMV疾病的策略需要考虑患者特定的风险因素以及实际因素，如可用资源。
