Haidar Ghady, Boeckh Michael, Singh Nina
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
J Infect Dis. 2020 Mar 5;221(Suppl 1):S23-S31. doi: 10.1093/infdis/jiz454.
This review focuses on recent advances in the field of cytomegalovirus (CMV). The 2 main strategies for CMV prevention are prophylaxis and preemptive therapy. Prophylaxis effectively prevents CMV infection after solid organ transplantation (SOT) but is associated with high rates of neutropenia and delayed-onset postprophylaxis disease. In contrast, preemptive therapy has the advantage of leading to lower rates of CMV disease and robust humoral and T-cell responses. It is widely used in hematopoietic cell transplant recipients but is infrequently utilized after SOT due to logistical considerations, though these may be overcome by novel methods to monitor CMV viremia using self-testing platforms. We review recent developments in CMV immune monitoring, vaccination, and monoclonal antibodies, all of which have the potential to become part of integrated strategies that rely on viral load monitoring and immune responses. We discuss novel therapeutic options for drug-resistant or refractory CMV infection, including maribavir, letermovir, and adoptive T-cell transfer. We also explore the role of donor factors in transmitting CMV after SOT. Finally, we propose a framework with which to approach CMV prevention in the foreseeable future.
本综述聚焦于巨细胞病毒（CMV）领域的最新进展。CMV预防的2种主要策略是预防性治疗和抢先治疗。预防性治疗可有效预防实体器官移植（SOT）后的CMV感染，但与中性粒细胞减少症的高发生率以及预防性治疗后延迟发病的疾病相关。相比之下，抢先治疗的优势在于导致CMV疾病的发生率较低，以及产生强大的体液和T细胞反应。它在造血细胞移植受者中广泛使用，但由于后勤方面的考虑，在SOT后很少使用，不过使用自我检测平台监测CMV病毒血症的新方法可能会克服这些问题。我们综述了CMV免疫监测、疫苗接种和单克隆抗体方面的最新进展，所有这些都有可能成为依赖病毒载量监测和免疫反应的综合策略的一部分。我们讨论了针对耐药或难治性CMV感染的新治疗选择，包括马立巴韦、来特莫韦和过继性T细胞转移。我们还探讨了供体因素在SOT后传播CMV中的作用。最后，我们提出了一个在可预见的未来应对CMV预防的框架。
