Introduction

This section includes regimens for antiviral prophylaxis (universal prophylaxis) and pre-emptive treatment of cytomegalovirus (CMV) infection in immunocompromised adults without HIV infection.

To assess if CMV universal prophylaxis or pre-emptive treatment is indicated, see Assessing the need for antimicrobial prophylaxis in immunocompromised adults without HIV infection.

The two approaches for patient management are:

The approach depends on several factors, including the availability of CMV monitoring and the risk of CMV reactivation. Some units use a hybrid approach, with universal prophylaxis during the first 30 days after allogeneic haematopoietic stem cell transplant (HSCT) and a switch to pre-emptive therapy thereafter.

If valganciclovir or ganciclovir are given for CMV prophylaxis, aciclovir or valaciclovir are not needed for herpes simplex virus (HSV) or varicella-zoster virus (VZV) prophylaxis.

Note: CMV prophylaxis with valganciclovir or ganciclovir provides prophylaxis against herpes simplex virus and varicella-zoster virus.

International guidelines¹ are available for further information about CMV management (including prophylaxis) in solid organ transplant patients.

For treatment and secondary prophylaxis of CMV infection, see Cytomegalovirus (CMV) infection.

¹ Kotton CN, Kumar D, Caliendo AM, Huprikar S, Chou S, Danziger-Isakov L, et al. The Third International Consensus Guidelines on the Management of Cytomegalovirus in Solid Organ Transplantation. Transplantation 2018. [URL]Return