Salmon-Céron D
Service de Médecine Interne 2, Hôpital Cochin, Paris.
Ann Med Interne (Paris). 1997;148(3):246-54.
Seroprevalence for CMV varies from 70% in the general population to more than 90% in HIV infected patients. Immunodepression whatever its origin, either post therapeutic as in transplant recipients, or induced by HIV, leads to the reactivation of this virus, present in a latent form in the host. In CMV-seronegative patients, the main prevention is based on donor matching before a graft (graft of seronegative donor) and on the use of seronegative blood products or deleukocyted blood. Since the availability of efficient strategies of prophylaxis (before infection) or of early treatment (pre-emptive therapy), CMV disease is now infrequent in most transplantation centers. A real prophylaxis with ganciclovir is usually selected in high risk patients (lung, bone marrow transplants in case of a CMV seropositive recipient or seronegative but with a seropositive donor). It has replaced in most centers aciclovir that has only a modest efficacy. A pre-emptive therapy by ganciclovir is proposed in case of lower risk of CMV disease (kidney, liver or heart transplants) or if the local virology laboratory provides sensitive virological markers to detect the first signs of CMV reactivation. Besides viremia or pp65 antigenemia, currently used to initiate a pre-emptive therapy, the standardisation of other virological markers such as leukocytic or plasmatic PCR is in progress. The prophylaxis of CMV disease in less developed for HIV infected patients. Immunosuppression, continuously progressing in absence of antiretroviral agents, requires a continuous prophylaxis for months or years, treatment that is difficult to propose at the present time considering the modest activity of oral ganciclovir, the only oral agent available. Future progresses in this field will be obtained when a sensitive and reproductible CMV marker will allow to identify the patients at highest risk of CMV disease, and with new anti-CMV agents having a good oral bioavailability.
巨细胞病毒（CMV）的血清阳性率在普通人群中为70%，在HIV感染患者中则超过90%。无论免疫抑制的起因如何，无论是移植受者治疗后的免疫抑制，还是由HIV引起的免疫抑制，都会导致这种以潜伏形式存在于宿主体内的病毒重新激活。在CMV血清阴性的患者中，主要预防措施基于移植前供体匹配（血清阴性供体移植）以及使用血清阴性血液制品或去白细胞血液。自从有了有效的预防策略（感染前）或早期治疗策略（抢先治疗）后，CMV疾病在大多数移植中心现在已不常见。对于高危患者（CMV血清阳性受者或血清阴性但供体血清阳性的肺、骨髓移植患者），通常选择用更昔洛韦进行真正的预防。在大多数中心，它已取代了疗效一般的阿昔洛韦。对于CMV疾病风险较低的情况（肾、肝或心脏移植），或者如果当地病毒学实验室能提供敏感的病毒学标志物以检测CMV重新激活的最初迹象，则建议采用更昔洛韦抢先治疗。除了目前用于启动抢先治疗的病毒血症或pp65抗原血症外，其他病毒学标志物如白细胞或血浆PCR的标准化工作正在进行中。对于HIV感染患者，CMV疾病的预防措施发展较缓慢。在没有抗逆转录病毒药物的情况下，免疫抑制持续进展，需要连续数月或数年进行预防，考虑到目前唯一可用的口服药物更昔洛韦的活性一般，目前很难提出这样的治疗方案。当一种敏感且可重复的CMV标志物能够识别出CMV疾病风险最高的患者，并且有新的具有良好口服生物利用度的抗CMV药物时，该领域将会取得未来的进展。
