Human cytomegalovirus: clinical aspects, immune regulation, and emerging treatments

• Published in: The Lancet infectious diseases Vol. 4; no. 12; p. 725
• Main Authors: Gandhi, Maher K, Khanna, Rajiv
• Format: Journal Article
• Language: English
• Published: United States 01-12-2004
• Subjects: Age Factors; Antiviral Agents - adverse effects; Antiviral Agents - therapeutic use; Cytomegalovirus - immunology; Cytomegalovirus - physiology; Cytomegalovirus Infections - drug therapy; Cytomegalovirus Infections - immunology; Disease Reservoirs; Humans; Immunocompetence; Immunocompromised Host; Immunosuppression; Immunotherapy; Treatment Outcome; Viral Load; Virus Replication; Virus Shedding
• ISSN: 1473-3099
• DOI: 10.1016/S1473-3099(04)01202-2

After initial infection, human cytomegalovirus remains in a persistent state with the host. Immunity against the virus controls replication, although intermitent viral shedding can still take place in the seropositive immunocompetent person. Replication of cytomegalovirus in the absence of an effective immune response is central to the pathogenesis of disease. Therefore, complications are primarily seen in individuals whose immune system is immature, or is suppressed by drug treatment or coinfection with other pathogens. Although our increasing knowledge of the host-virus relationship has lead to the development of new pharmacological strategies for cytomegalovirus-associated infections, these strategies all have limitations-eg, drug toxicities, development of resistance, poor oral bioavailability, and low potency. Immune-based therapies to complement pharmacological strategies for the successful treatment of virus-associated complications should be prospectively investigated.