How is CMV infection treated?
Ganciclovir and valganciclovir are the most commonly used agents for the treatment of CMV infection. Both drugys must be dosed based on renal function. Valganciclovir is indicated in patients with mild to moderate disease. The treatment dose with normal kidney function is 900 mg twice daily. The dose needs to be reduced in kidney failure. Ganciclovir is indicated in more severe disease, those with high viral load, or those with questionable gastrointestinal absorption. Treatment is usually continued until the viral load is undetectable for 2 weeks, then the patient is switched to 1 to 3 months of prophylactic therapy. If the viral load does not change with appropriately dosed ganciclovir after 2 to 3 weeks, then ganciclovir resistance should be assessed by viral genotype testing. If resistance is discovered, the usual strategy is to increase the ganciclovir dose or use foscarnet or cidofovir. However, these are nephrotoxic. The other aspect of treatment is the careful reduction of immunosuppression.