GANCICLOVIR FOR NEONATAL HEPATITIS CYTOMEGALOVIRUS (CMV)

Andi Cahyadi

School of Medicine, Airlangga University / dr. Soetomo Hospital Surabaya

Neonatal hepatitis CMV refers to morphology's changes in the liver of an infant <3 months of age, caused CMV, Approximately 40% of cholestasis in infants is due to neonatal hepatitis. It may cause latent or acute cholestatic or chronic hepatitis, including cirrhosis. Virus replicates in hepatocytes and cholangiocytes.

Ganciclovir is recommended as a first step antiviral for congenital CMV but it is controversial. Ganciclovir is a nucleoside analogue of guanosin than converted to ganciclovir triphosphat which inhibit viral DNA polymerases by competitive inhibiting the incorporation of deoxyguanosin triphosfat into elongating viral DNA. The intravenous administration is 5 mg/kg body weight over one hour twice daily for at least 2-3 weeks. By the end of therapy, 75% had negative CMV DNA and showed significant decreases in transaminase and bilirubin levels. Most common adverse effects include dose-dependent neutropenia and trombocitopenia.

The long-term outcome of CMV hepatitis is unpredictable and some have persistent liver injury despite ganciclovir therapy. Ganciclovir is not indicated particularly in immunocompetent cases, since most were self-limited, in case of progressive and persistent hepatitis, ganciclovir was a treatment option. Because of serious side-effects, the cost-benefit of ganciclovir should be carefully evaluated. Ganciclovir seems to be effective in progressive CMV hepatitis, large multi center randomized studies are necessary to determine the efficacy and indications.

Structure Cytomegalovirus

Structure ganciclovir