Ganciclovir therapy for cytomegalovirus-associated liver disease in immunocompetent or immunocompromised children

• Published in: Archives of virology 1997-01, Vol.142 (3), p.573-580
• Main Authors: Nigro, G, Krzysztofiak, A, Bartmann, U, Clerico, A, Properzi, E, Valia, S, Castello, M
• Format: Article
• Language: English
• Subjects: acquired immunodeficiency syndrome; AIDS-Related Opportunistic Infections - congenital; AIDS-Related Opportunistic Infections - drug therapy; AIDS-Related Opportunistic Infections - immunology; alanine transaminase; Antiviral Agents - therapeutic use; blood; Child; Child, Preschool; children; Children & youth; Cytomegalovirus; Cytomegalovirus Infections - complications; Cytomegalovirus Infections - congenital; Cytomegalovirus Infections - drug therapy; Cytomegalovirus Infections - immunology; Disease; DNA; Follow-Up Studies; Ganciclovir - adverse effects; Ganciclovir - therapeutic use; Humans; Immunocompetence; Immunocompromised Host; Infant; Infant, Newborn; liver; Liver - ultrastructure; Liver cirrhosis; Liver diseases; Liver Diseases - complications; Liver Diseases - congenital; Liver Diseases - drug therapy; Liver Diseases - immunology; liver failure; neoplasms; Neoplasms - complications; parturition; therapeutics; urine; viral antigens
• ISSN: 0304-8608; 1432-8798
• DOI: 10.1007/s007050050103

Ganciclovir therapy was given intravenously to 20 children with cytomegalovirus (CMV)-associated liver disease, of whom 6 were immunocompetent and 14 were immunocompromised (9 had AIDS and 5 had solid tumors). Immunocompetent children had isolated liver disease diagnosed at birth (4 children), or systemic congenital CMV infection including liver disease (2 children). Ganciclovir was used following two regimens: A) 5 mg/kg twice daily for 8 to 86 days (mean 21); B) 7.5 mg/kg twice daily for 14 days followed by 10 mg/kg three times weekly for three months. CMV infection was diagnosed by viral isolation, detection of viral antigens, and/or CMV DNA from blood and urine. All immunocompetent children had negative CMV culture and CMV DNA detection from blood and/or urine after 14 weeks of treatment. However, the three children who were treated with regimen B showed normal ALT levels at the end of the maintenance course, whereas the children who received ganciclovir with regimen A had normal ALT levels only after about 1 year. All children with tumors initiated regimen B, but only three, who had negative CMV detection and markedly decreased ALT levels, received full treatment; of the remaining two children, one recovered after only an initial course, and the other had therapy interrupted because of hepatic failure and died 9 days later. In contrast, the children with AIDS received several ganciclovir courses for different periods at the lower dosage: they generally improved during treatment but did not recover completely, and five children died with active CMV infections. Based on our study, CMV-associated liver disease can be efficiently treated with ganciclovir both in immunocompetent and immunodeficient children. However, a single ganciclovir course including a higher dosage and prolonged therapy appeared to be more effective than several courses with lower dosages.