Intrauterine therapy of cytomegalovirus infection with valganciclovir: review of the literature

Congenital cytomegalovirus (CMV) infection is the leading cause for sensorineural hearing loss and mental retardation in children without genetic diseases worldwide. There is little evidence guiding therapeutic strategies during pregnancy when intrauterine fetal CMV infection is confirmed. We provid...

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Bibliographic Details
Published in:Medical microbiology and immunology 2017-10, Vol.206 (5), p.347-354
Main Authors: Seidel, Vera, Feiterna-Sperling, Cornelia, Siedentopf, Jan-Peter, Hofmann, Jörg, Henrich, Wolfgang, Bührer, Christoph, Weizsäcker, Katharina
Format: Article
Language:English
Subjects:
Antiviral Agents - administration & dosage
Antiviral Agents - adverse effects
Antiviral drugs
Biomedical and Life Sciences
Biomedicine
Case reports
Children
Congenital diseases
Cytomegalovirus
Cytomegalovirus Infections - drug therapy
Drug-Related Side Effects and Adverse Reactions
Female
Fetal Diseases - drug therapy
Fetuses
Ganciclovir
Ganciclovir - administration & dosage
Ganciclovir - adverse effects
Ganciclovir - analogs & derivatives
Hearing loss
Humans
Immunology
Infections
Literature reviews
Long-term effects
Medical Microbiology
Motivation
Pregnancy
Pregnancy Complications, Infectious - drug therapy
Review
Treatment Outcome
Virology
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Summary:Congenital cytomegalovirus (CMV) infection is the leading cause for sensorineural hearing loss and mental retardation in children without genetic diseases worldwide. There is little evidence guiding therapeutic strategies during pregnancy when intrauterine fetal CMV infection is confirmed. We provide a systematic review of the use of ganciclovir (GCV) or VGCV during pregnancy discussing safety of its use for mother and fetus and describe two cases of intrauterine therapy of fetal CMV infection with valganciclovir (VGCV). A PubMed database search was done up to November 16, 2016 without any restrictions of publication date or journal, using the following keywords: “valganciclovir” or “ganciclovir” and “pregnan*”. Furthermore, citations were searched and expert references were obtained. Reported cases were considered if therapy was in humans and initiation of treatment of the CMV infection was during pregnancy. In total, seven case reports were retrieved which described GCV or VGCV use during pregnancy for fetal or maternal CMV infection. In the four cases of treatment for maternal CMV infection, no negative effects on the fetus were reported. Three cases of GCV administration to pregnant woman with the intention of fetal treatment after proven fetal infection were found. We additionally present two cases of VGCV treatment in pregnancy from our center of tertiary care. VGCV seems to be a safe treatment for congenital CMV infection for the mother and the fetus. Therapeutic concentrations can be achieved in the fetus by oral intake of the mother and CMV replication can be suppressed. Larger studies are needed to evaluate this therapeutic intervention and the long-term effects.
ISSN:0300-8584
1432-1831
DOI:10.1007/s00430-017-0512-3