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
