Acosta Edward, Bowlin Terry, Brooks Jennifer, Chiang Lillian, Hussein Islam, Kimberlin David, Kauvar Lawrence M, Leavitt Randi, Prichard Mark, Whitley Richard
Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Microbiotix, Inc, Worcester, Massachusetts, USA.
J Infect Dis. 2020 Mar 5;221(Suppl 1):S32-S44. doi: 10.1093/infdis/jiz493.
The development of therapeutics for cytomegalovirus (CMV) infections, while progressing, has not matched the pace of new treatments of human immunodeficiency virus (HIV) infections; nevertheless, recent developments in the treatment of CMV infections have resulted in improved human health and perhaps will encourage the development of new therapeutic approaches. First, the deployment of ganciclovir and valganciclovir for both the prevention and treatment of CMV infections and disease in transplant recipients has been further improved with the licensure of the efficacious and less toxic letermovir. Regardless, late-onset CMV disease, specifically pneumonia, remains problematic. Second, the treatment of congenital CMV infections with valganciclovir has beneficially improved both hearing and neurologic outcomes, both fundamental advances for these children. In these pediatric studies, viral load was decreased but not eliminated. Thus, an important lesson learned from studies in both populations is the need for new antiviral agents and the necessity for combination therapies as has been shown to be beneficial in the treatment of HIV infections, among others. The development of monoclonal antibodies, sirtuins, and cyclopropovir may provide new treatment options.
巨细胞病毒（CMV）感染治疗方法的发展虽在推进，但仍跟不上人类免疫缺陷病毒（HIV）感染新疗法的发展步伐；然而，CMV感染治疗领域的近期进展已改善了人类健康状况，或许还会推动新治疗方法的研发。首先，随着高效低毒的来特莫韦获批上市，更昔洛韦和缬更昔洛韦在预防和治疗移植受者CMV感染及疾病方面的应用得到了进一步改善。尽管如此，迟发性CMV疾病，尤其是肺炎，仍然是个问题。其次，用缬更昔洛韦治疗先天性CMV感染已有益地改善了听力和神经学转归，这对这些儿童来说都是根本性的进展。在这些儿科研究中，病毒载量有所下降但并未消除。因此，从这两类人群的研究中得到的一个重要经验是，需要新的抗病毒药物以及联合疗法，正如在治疗HIV感染等疾病中已证明联合疗法是有益的。单克隆抗体、去乙酰化酶和环丙沙星的研发可能会提供新的治疗选择。
