Advances in the Development of Therapeutics for Cytomegalovirus Infections

Abstract

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.

Keywords: antiviral therapy; congenital cytomegalovirus; cyclopropovir; ganciclovir; letermovir; maribavir; monoclonal antibodies; sirtuins; valganciclovir.

Figure 1.

Whole blood cytomegalovirus DNA viral load. Reprinted from Kimberlin et al [31] with permission. Clearance of virus in congenitally infected infants who received either 6 weeks or 6 months of therapy. A rebound in virus titer occurred upon drug discontinuation.