Preemptive treatment for the prevention of cytomegalovirus disease: In lung and heart transplant recipients

Background. Rapid quantifiable diagnostic techniques for the diagnosis of cytomegalovirus (CMV) infection may predict patients at risk of CMV pneumonitis and allow preemptive antiviral treatment. Methods. Using CMV antigenemia as a prospective surveillance technique for CMV infection, we compared the outcome of preemptive treatment (PT) with ganciclovir, 10 mg/kg/day for 21 days directed by 'high levels' of CMV antigenemia (PT group, n=19), with the outcome in a group of historical controls (n = 18) treated with ganciclovir when CMV illness occurred. Greater than 50 antigen-positive cells per 2 x 105 polymorphonuclear leukocytes was considered to be high- level antigenemia. Results. Nine of the 18 controls developed high-level CMV antigenemia at a median of 38 days (range: 13-65 days) and 5 of the 9 developed CMV disease. Ten of the 19 PT group had high levels of CMV antigenemia detected at a median of 47 days (range: 20-63 days) and were given ganciclovir; none developed CMV disease. There was a significantly lower incidence of CMV disease in the PT group in comparison to controls (0 of 19 vs. 5 of 18: P=0.019). Conclusion. We have reduced the incidence of CMV disease using preemptive treatment, and because of a 100% negative predictive value, we omitted unnecessary antiviral prophylaxis for many at-risk patients.