Congenital Cytomegalovirus Infection: Management Update

Asma Khalil; Chrissie Jones; Yves Villec

Disclosures

Curr Opin Infect Dis. 2017;30(3):274-280. 

In This Article

Abstract and Introduction

Abstract

Purpose of review Until recently, management options in congenital cytomegalovirus (cCMV) infection have been either conservative or termination of pregnancy. However, medical therapies aimed at reducing the risk of infection and/or its severity have recently been investigated.

Recent findings In a phase 2 open label, nonrandomized trial, valaciclovir (ValACV) was given to women carrying a CMV-infected fetus. ValACV was associated with a greater proportion of asymptomatic neonates when compared with a historical cohort (82 vs. 43%). However, the study design and the small number of treated women limit its applicability. Even though initial observational data suggested that hyperimmune globulin (HIG) therapy in pregnancy was associated with a significantly lower risk of cCMV, its efficacy has not been borne out in a subsequent phase 2 randomized, placebo controlled, double-blind study [cCMV 30% in the HIG group, 44% in the placebo group (P = 0.13)]. Furthermore, 11% of fetuses in the HIG group had transient or permanent abnormalities, compared with 16% in the placebo group.

Summary ValACV might have a promising role in the antenatal treatment of cCMV infection, but definitive recommendations require further research. The use of HIG should currently be limited to the research setting.

Video abstract http://links.lww.com/COID/A18.

Introduction

Cytomegalovirus (CMV) is the commonest cause of congenital infection, the leading nongenetic cause of sensorineural hearing loss (SNHL), the major infectious cause of infant malformation in developed countries and a major cause of neurodisability.[1,2] It is estimated to account for up to 10% of cases of cerebral palsy.[3] The incidence of congenital CMV is estimated at 0.64%, whereas the incidence of symptomatic infection at birth is 0.07%.[4–7] Congenital CMV infection affects 40 000 infants in the United States annually.[8] In the UK, 1–2 in every 200 neonates will be born with congenital CMV. Of these, around 13% will be symptomatic at birth, with a similar proportion developing problems later in childhood.[9] Moderate or severe outcomes were reported in 11% of children with congenital CMV identified through population screening.[9]

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