Prenatal and postnatal antiviral therapies for the prevention and treatment of congenital cytomegalovirus infections.

IF 3.6 3区 医学 Q2 INFECTIOUS DISEASES Current Opinion in Infectious Diseases Pub Date : 2024-12-01 Epub Date: 2024-10-03 DOI:10.1097/QCO.0000000000001067
Preethi Chandrasekaran, Han-Shin Lee, Lisa Hui, Mark R Schleiss, Valerie Sung
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Abstract

Purpose of review: Congenital cytomegalovirus infection (cCMV) is the leading infectious cause of sensorineural hearing loss and lifelong neurodevelopmental disabilities. Studies suggest antiviral therapy can prevent fetal infection after maternal primary infection, as well as halt the progression of hearing loss and neurodevelopmental disabilities in newborns with symptomatic cCMV. With growing worldwide momentum on early detection and diagnosis of cCMV, this review describes the exciting recent advances in antiviral therapies in CMV infected pregnant mothers and babies, as well as emerging evidence on anti-CMV vaccines.

Recent findings: New opportunities for prenatal and neonatal interventions have driven a rising interest in screening and identification of asymptomatic CMV infection. Routine screening of pregnant women to identify primary infection in first trimester is now advocated in Western Europe but has yet to be examined from a public health perspective in other regions. Evidence is emerging for maternal valaciclovir therapy to prevent fetal infection after a maternal primary CMV infection in the first trimester of pregnancy. For those infants who are born with symptomatic cCMV, a 6-month course of valganciclovir, started within the first 4 weeks of life, and possibly up to 13 weeks of life, is the current recommended therapy. However, there is unclear evidence for the benefit of treatment for asymptomatic cCMV and cCMV with isolated hearing loss. Research to identify more effective antivirals and an effective CMV vaccine continues.

Summary: More research is needed to determine the region-specific applicability of the new European recommendations for routine CMV screening in pregnancy. Areas of uncertainty in postnatal management include timing of initiation, duration of treatment and identifying pediatric subgroups that benefit from modification of the standard treatment recommendations.

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预防和治疗先天性巨细胞病毒感染的产前和产后抗病毒疗法。
综述目的:先天性巨细胞病毒感染(cCMV)是导致感音神经性听力损失和终身神经发育障碍的主要传染病因。研究表明,抗病毒治疗可预防母体原发感染后的胎儿感染,并能阻止有症状的新生儿听力损失和神经发育障碍的进展。随着全球对 cCMV 早期检测和诊断的重视程度不断提高,本综述介绍了针对受 CMV 感染的孕妇和婴儿的抗病毒疗法取得的令人振奋的最新进展,以及有关抗 CMV 疫苗的新证据:产前和新生儿干预的新机遇促使人们对筛查和识别无症状 CMV 感染的兴趣与日俱增。目前,西欧提倡对孕妇进行常规筛查,以确定前三个月的原发性感染,但其他地区尚未从公共卫生的角度进行研究。有证据表明,在妊娠头三个月母体原发性 CMV 感染后,可采用伐昔洛韦治疗来预防胎儿感染。目前推荐的治疗方法是在婴儿出生后 4 周内开始对其进行为期 6 个月的缬更昔洛韦治疗,并有可能延长至出生后 13 周。然而,对于无症状的 cCMV 和伴有孤立性听力损失的 cCMV,治疗的益处尚无明确证据。小结:需要开展更多研究,以确定欧洲关于妊娠期常规 CMV 筛查的新建议在特定地区的适用性。产后管理中的不确定因素包括开始治疗的时机、治疗持续时间以及确定哪些儿科亚群可从修改标准治疗建议中获益。
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来源期刊
CiteScore
6.70
自引率
2.60%
发文量
121
审稿时长
6-12 weeks
期刊介绍: This reader-friendly, bimonthly resource provides a powerful, broad-based perspective on the most important advances from throughout the world literature. Featuring renowned guest editors and focusing exclusively on two topics, every issue of Current Opinion in Infectious Disease delivers unvarnished, expert assessments of developments from the previous year. Insightful editorials and on-the-mark invited reviews cover key subjects such as HIV infection and AIDS; skin and soft tissue infections; respiratory infections; paediatric and neonatal infections; gastrointestinal infections; tropical and travel-associated diseases; and antimicrobial agents.
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