Institute for Immunity and Transplantation, University College London, London, UK.
Nat Rev Microbiol. 2021 Dec;19(12):759-773. doi: 10.1038/s41579-021-00582-z. Epub 2021 Jun 24.
Human cytomegalovirus (HCMV) is a herpesvirus that infects ~60% of adults in developed countries and more than 90% in developing countries. Usually, it is controlled by a vigorous immune response so that infections are asymptomatic or symptoms are mild. However, if the immune system is compromised, HCMV can replicate to high levels and cause serious end organ disease. Substantial progress is being made in understanding the natural history and pathogenesis of HCMV infection and disease in the immunocompromised host. Serial measures of viral load defined the dynamics of HCMV replication and are now used routinely to allow intervention with antiviral drugs in individual patients. They are also used as pharmacodynamic read-outs to evaluate prototype vaccines that may protect against HCMV replication and to define immune correlates of this protection. This novel information is informing the design of randomized controlled trials of new antiviral drugs and vaccines currently under evaluation. In this Review, we discuss immune responses to HCMV and countermeasures deployed by the virus, the establishment of latency and reactivation from it, exogenous reinfection with additional strains, pathogenesis, development of end organ disease, indirect effects of infection, immune correlates of control of replication, current treatment strategies and the evaluation of novel vaccine candidates.
人巨细胞病毒（HCMV）是一种疱疹病毒，在发达国家约有 60%的成年人感染，在发展中国家则超过 90%。通常情况下，它会被强大的免疫反应所控制，因此感染通常无症状或症状轻微。然而，如果免疫系统受损，HCMV 可能会大量复制并导致严重的终末器官疾病。目前，人们对免疫功能低下宿主中 HCMV 感染和疾病的自然史和发病机制有了实质性的了解。病毒载量的连续测量定义了 HCMV 复制的动力学，现在常规用于对个体患者进行抗病毒药物干预。它们还可用作药效学指标，以评估预防 HCMV 复制的原型疫苗，并确定这种保护的免疫相关性。这些新信息为目前正在评估的新型抗病毒药物和疫苗的随机对照试验设计提供了依据。在这篇综述中，我们讨论了针对 HCMV 的免疫反应和病毒采取的对策、潜伏期的建立和由此引发的再激活、来自其他毒株的外源性再感染、发病机制、终末器官疾病的发展、感染的间接影响、复制控制的免疫相关性、当前的治疗策略以及新型疫苗候选物的评估。
