This document discusses whether valganciclovir is the best preventive treatment for cytomegalovirus (CMV). It begins by introducing CMV as a herpes virus that infects over 80% of adults without symptoms. The document then reviews several studies that tested valganciclovir or ganciclovir treatments in transplant patients and infants. The studies found success rates from 68-96% depending on dosage and duration. The document concludes that valganciclovir is superior to other approved treatments and that combining intravenous then oral medications provides the best prevention and treatment of CMV.

1. Is valganciclovir, or its intravenous
equivalent, the best preventive
treatment for Cytomegalovirus?
Delaine M. Zayas-Bazán Burgos

2. Introduction
“all true viruses have four characteristics: They contain
one and only one type of nucleic acid; they are
reproduced from their genetic material and in the form
of their genetic material; they do not grow, and they do
not undergo binary fission; and they posses no enzyme
systems for energy production.”
Lwoff (1959)

3. Introduction
 Cytomegalovirus
 Is part of the
herpes virus
family
 Has a latency and
reactivation
mechanism
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4. Introduction
 Currently more that 80% of the adult
population of the world is infected with
cytomegalovirus
 Most of this population live their life
without ever knowing it

5. Introduction
 Objective:
Prove that valganciclovir and
ganciclovir are the best treatment
in the prevention of
cytomegalovirus.

6. Development

7. Treatments
 Antiviral drugs
 They do not destroy the virus like antibiotics destroy
bacteria
 They attack the virus by
 preventing the spread
 slowing the growth
 inhibiting its capacity to reproduce

8. Treatments
Valganciclovir
is the best known
treatment for
cytomegalovirus
infection and
prevention
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9. Treatments
In the human
body,
valganciclovir
changes into
ganciclovir.
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10. Effectiveness: The evidence
Investigation’s
description
Dosage and Sample Length of the
study
Success
Title: Oral valganciclovir
versus intravenous
ganciclovir as preemptive
treatment for
cytomegalovirus infection
after living donor liver
transplantation: A
randomized trial
Authors: Junichi Togashi,
Yasuhiko Sugawara1,
Masao Hashimoto, Sumihito
Tamura, Junichi Kaneko,
Taku Aoki, Kiyoshi
Hasegawa, Norihiro Kokudo
Dosage: 900 milligrams per
day of oral valganciclovir or
5 milligrams per kilograms
twice a day of intravenous
ganciclovir
Sample: 22 liver
transplanted patients, 11 for
each group.
Length: the
patients received
the medication for
180 days.
(approximately 6
months)
Follow-up: the
patients were
followed 1 year
after transplant, and
three years after
completion of the
study.
Valganciclovir group:
82%
Ganciclovir group: 91%
“In both groups, the
overall
1-year survival rate after
LDLT was 100%. The 1-
and
3-year patient survival
rates with CMV infection
were
96% and 96%, versus
95% and 95% without
CMV.”

11. Effectiveness : The evidence
Title: Treatment of
symptomatic
congenital
cytomegalovirus
infection with
intravenous
ganciclovir followed
by long-term
oral valganciclovir
Authors: Jacob
Amir, Dana G. Wolf
and Itzhak Levy
Dosage: 5 milligrams
per kilogram of
intravenous ganciclovir,
every 12 hours for 6
weeks. Afterwards they
were administered 450
milligrams tablets of oral
valganciclovir, every 12
hours for t 6 weeks.
Then one daily dose up
to age 1 year. (The dose
was adjusted to child’s
growth after every
kilogram of weight they
gained)
Sample: 23 infants
born with
cytomegalovirus
Length: The
study was
performed in
1,800 days
(Approximately
60 weeks, 13
months or a year
and one month)
Follow-up: The
infants were
followed until
they were three
years old.
The overall
success was of
76% of
improvement in
the affected
ears. In the
other conditions
caused by the
virus the
success was
great. Many of
the infants
developed
normally after
12 months of
age.

12. Effectiveness : The evidence
Title: Extended
Valganciclovir Prophylaxis to
Prevent Cytomegalovirus
After
Lung Transplantation
Authors: Scott M. Palmer,
Ajit P. Limaye, Missy Banks,
Dianne Gallup, Jeffrey
Chapman, E. Clinton
Lawrence, Jordan Dunitz,
Aaron Milstone, John
Reynolds, Gordon L. Yung,
Kevin M. Chan, Robert Aris,
Edward Garrity, Vincent
Valentine, Jonathan McCall,
Shein-Chung Chow, Robert
Duane Davis, and Robin
Avery.
Dosage: intravenous
ganciclovir for two
weeks after surgery
and then 900
milligrams of oral
valganciclovir once a
day
Sample: 157 lung
transplant patients that
had received the
standard 3-months
preemptive treatment.
Length: 12
months of
oral
valganciclovir
treatment
Follow-up:
The patients
were followed
for 6 months
after the
study’s
completion.
Short-term group:
68% of success (only
32% showed
cytomegalovirus
occurrence)
Long-term group:
96% of success (only
4% of cytomegalovirus
occurrence)

13. Effectiveness : The evidence
 The results show:
 The effectiveness
 Different variables that promote better
outcomes
 That it did not cause serious or
unmanageable secondary symptoms
 The eligibility of different sectors of the
risk population

14. Conclusions

15. Conclusions
 More treatments in the prevention of
cytomegalovirus should be developed
 There is not enough information,
although the virus is highly common
 The best way to prevent and treat
cytomegalovirus is to combine both

16. Conclusion
 Compared to the other two medications
approved, foscarnet and cidofovir,
valganciclovir is superior
 Both remain as second-line therapy
 “GCV is the first agent approved by the Food and
Drug Administration to treat severe CMV and
since 1990 it is the most used drug for congenital
symptomatic disease”. (Lombardi, Garofoli,
Stronati 2010)

17. Conclusions
 Some variables affected the different
outcomes providing essential
information for further researches
 The treatment should be exposed in
order to help larger sectors of the
community struggling with this virus

18. References

19. References
 Amir J, Levy I, Wolf DG. 2010. Treatment of symptomatic congenital
cytomegalovirus infection with intravenous ganciclovir followed by long-term
oral valganciclovir. European Journal of Pediatrics [Internet]; [revised 201 January
13; Cited: 2012 October 19]. DOI 10.1007/s00431-010-1176-9:1061–1067. Available
at: http://www.springerlink.com/content/bg650327335h16r0/fulltext.html
 Aoki T, Hasegawa K, Hashimoto M, Kaneko J, Kokudo N, Sugawara Y, Tamura
S, Togashi J. 2011. Oral valganciclovir versus intravenous ganciclovir as
preemptive treatment for cytomegalovirus infection after living donor liver
transplantation: A randomized trial. BioScience Trends [Internet]; [revised 2011
September 26; Cited: 2012 October 12].DOI:10.5582/bst.2011.v5.5.217:217-222.
Available at:
http://web.ebscohost.com.uprcdb.cayey.upr.edu:2048/ehost/pdfviewer/pdfvie
wer?sid=f754d515-ff02-48c5-a7be-
ba0eea36253a%40sessionmgr112&vid=5&hid=106

20. References
 Aris R, Avery R, Banks M, Chan KM, Chapman J, Chow S-C, Davis
RD, Dunitz J, Gallup D, Garrity E, Lawrence EC, Limaye AP, McCall J,
Milstone A, Palmer SM, Reynolds J, Valentine V, Yung GL. 2010.
Extended Valganciclovir Prophylaxis to Prevent Cytomegalovirus
After Lung Transplantation: A Randomized, Controlled Trial. Annals
of Internal Medicine. [Internet]; [Cited: 2012 November 1].
152(12):761-769. Available at:
http://annals.org/article.aspx?articleid=745830
 Biron KK. 2006. Antiviral drugs for cytomegalovirus diseases.
Elsevier. [Internet]; [Cited: 2012 November 20]. 71:154–163.
doi:10.1016/j.antiviral.2006.05.002 Available at:
http://www.idpublications.com/journals/pdfs/avres/avres_mostcit
ed_1.pdf

21. References
 Bloom RD, Blumberg E, Trofe-Clark J, Wade Ticehurst E. 2010. Valganciclovir for
the prophylaxis and treatment of cytomegalovirus infection in solid organ
transplantation. Transplant Research and Risk Management. [Internet]; [Cited: 2012
November 18]. 2010(2): 29-39. DOI:http://dx.doi.org/10.2147/TRRMS5979
Available at: http://www.dovepress.com/valganciclovir-for-the-prophylaxis-and-
treatment-of-cytomegalovirus-in-peer-reviewed-article-TRRM
 Christiansen CB, Cunha-Bang C, Fox ZV, Hillings JG, Iversen M, Kirkby NS,
Lundgren JD, Mortensen SA, Rasmussen A, Sengel VH, Sorensen SS. 2010. Factors
associated with the development of cytomegalovirus infection following solid organ
transplantation. Scandinavian Journal of Infectious Diseases. [Internet]; [Cited: 2012
December 7]. 43: 360–365. DOI: 10.3109/00365548.2010.549836. Available at:
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=f8f3123a-7b4c-4229-9c76-6163b0175560%40sessionmgr114&vid=1&hid=104

22. References
 Garofoli F, Lombardi G, Stronati M. 2010. Congenital cytomegalovirus infection:
treatment, sequelae and follow-up. The Journal of Maternal-Fetal and Neonatal
Medicine. [Internet]; [Cited: 2012 December 7]. 23: 45–48. DOI:
10.3109/14767058.2010.506753. . Available at:
http://web.ebscohost.com.uprcdb.cayey.upr.edu:2048/ehost/pdfviewer/pdfviewer?sid=b
ad51aef-4205-481d-a6a0-a3970a1cd335%40sessionmgr113&vid=1&hid=104
 Goodheart CR. 1969. An Introduction to Virology. Chicago (Illinois): W.B.
Saunders Company. What is a Virus?; p 364
 Goodheart CR. 1969. An Introduction to Virology. Chicago (Illinois): W.B.
Saunders Company. Tumor Viruses that contain DNA; p 334-336.
 Razonable RR and Emery VC. 2004. Management of CMV infection and
disease in transplant patients. Management Recommendations. 11: 77–86

23. Questions