Rinaldo Christine Hanssen, Hirsch Hans H
University Hospital of North Norway, Department of Microbiology and Infection Control, PO Box 56, N-9038 Tromsø, Norway. christine.rinaldo@unn
Expert Rev Anti Infect Ther. 2007 Feb;5(1):105-15. doi: 10.1586/14787210.5.1.105.
Antiviral drugs with specific activity against polyomavirus replication have not been developed in the past. This deficiency has become fully apparent with the emergence of polyomavirus-associated nephropathy in kidney-transplant recipients, with a prevalence rate of up to 10%. In most cases, high BK virus replication in tubular epithelial cells causes significant cytopathology, leading to permanently impaired renal allograft function and return to hemodialysis within 6-60 months. In 5-10% of allogenic bone marrow/hematopoietic stem cell transplant recipients, high-level BK virus replication in the ureter/bladder mucosa has been associated with postengraftment hemorrhagic cystitis, which appears to involve significant immunopathology. Thus, in view of the increasing clinical need, a number of drugs have been studied in small case series. We review the antiviral strategies explored to date and specifically discuss available in vivo and in vitro data on cidofovir, leflunomide, fluoroquinolones and intravenous immunoglobulins, regarding mechanism, administration, dosing and outcome and provide a perspective on future therapy options.
过去尚未研发出对多瘤病毒复制具有特异性活性的抗病毒药物。随着肾移植受者中多瘤病毒相关性肾病的出现，这一缺陷已变得十分明显，其患病率高达10%。在大多数情况下，肾小管上皮细胞中BK病毒的高复制会导致明显的细胞病理学变化，致使肾移植功能永久受损，并在6至60个月内恢复血液透析。在5%至10%的同种异体骨髓/造血干细胞移植受者中，输尿管/膀胱黏膜中BK病毒的高水平复制与移植后出血性膀胱炎有关，这似乎涉及显著的免疫病理学。因此，鉴于临床需求不断增加，已在小病例系列中对多种药物进行了研究。我们回顾了迄今为止探索的抗病毒策略，并特别讨论了关于西多福韦、来氟米特、氟喹诺酮类药物和静脉注射免疫球蛋白的现有体内和体外数据，涉及作用机制、给药方式、剂量和疗效，并对未来的治疗选择提供了展望。
