Review of Intravesicular Cidofovir for BK Virus Hemorrhagic Cystitis

• Published in: Current treatment options in infectious disease 2021-09, Vol.13 (3), p.100-110
• Main Authors: Palacio, Danica, Prakash, Katya, Riedel, David J.
• Format: Article
• Language: English
• Subjects: Antiviral agents; Children; Cidofovir; Clinical trials; Cystitis; Hematopoietic stem cells; Hemorrhage; Hemorrhagic cystitis; Immunosuppression; Infectious Diseases; Intravenous administration; Literature reviews; Medicine; Medicine & Public Health; Patients; Section Editor; Symptom management; Topical Collection on Transplant/Immunocompromised Hosts; Toxicity; Transplant/Immunocompromised Hosts (M Morales
• ISSN: 1534-6250; 1523-3820; 1534-6250
• DOI: 10.1007/s40506-021-00251-y

Purpose of Review BK virus (BKV) reactivation in immunosuppressed patients, specifically in patients following allogeneic hematopoietic stem cell transplant, can result in hemorrhagic cystitis (HC). The mainstay of treatment to date has been a reduction of immunosuppression and symptom management; the utility of antiviral therapy has been uncertain. Several recent studies have reported the outcomes of intravesicular instillation of the antiviral agent cidofovir for treating this infection. This paper seeks to summarize the current literature on intravesicular cidofovir treatment for BKV-induced hemorrhagic cystitis (BKV-HC). Recent Findings The literature review identified 116 patients, both adults and children, in 17 studies, who received intravesicular cidofovir for the treatment of BKV-HC. Complete clinical response was observed in 72% (58/81) of adults and 74% (26/35) of children across the reported studies. No permanent systemic toxicities were reported with intravesicular cidofovir, in contrast with intravenous use, which was associated with significant nephrotoxicity. However, bladder pain and spasms after instillation of CDV were reported by 20–50% of patients across the various studies. Summary Intravesicular cidofovir shows promise in treating BKV-HC with minimal reported toxicity. However, a majority of reports are retrospective case studies and are limited by small sample sizes and no control groups. Further investigation through randomized controlled trials is warranted to guide the use of intravesicular cidofovir for this common post-transplant complication.