Cytomegalovirus infection in non– human immunodeficiency virus– infected patients: a hematologist perspective

Abstract

Cytomegalovirus is an opportunistic pathogen in immunocompromised patients, particularly those infected with the human immunodeficiency virus. In non–human immunodeficiency virus–infected patients, including patients with hematological malignancies and those undergoing hematopoietic stem cell transplantation, cytomegalovirus infection also leads to significant morbidity and mortality. The high cytomegalovirus seroprevalence in our locality explains the vulnerability of immunocompromised subjects to cytomegalovirus reactivation. Recipients of allogeneic hematopoietic stem cell transplantation and patients treated with certain chemotherapeutic drugs for hematological malignancies are at high risk of cytomegalovirus reactivation. Cytomegalovirus disease is associated with a wide range of clinical manifestations, as almost any organ can be involved. Histopathology remains the gold standard to confirm end-organ cytomegalovirus involvement, although pp65 antigenemia assay and quantitative polymerase chain reaction of viral DNA are useful tools in daily practice. Nevertheless, peripheral blood-based assays may not be positive in patients with cytomegalovirus involving organs including the gastrointestinal tract, brain and eye. Different treatment approaches are used in the management of cytomegalovirus infection, including prophylactic, preemptive and therapeutic strategies. Ganciclovir and its oral prodrug valganciclovir remain the cornerstone treatment of cytomegalovirus disease, albeit at the risk of increased myelosuppression. Alternatively, foscarnet may be used in cytopenic patients. Clinical vigilance and multidisciplinary collaborations are of paramount importance in the management of cytomegalovirus infection.