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Optimal Strategy for CMV Prevention in HCT

CE / CME

Reducing the Burden of Cytomegalovirus in HCT: Optimal Strategy for Prevention

Physician Assistants/Physician Associates: 1.00 AAPA Category 1 CME credit

Nurse Practitioners: 1.00 Nursing contact hours, includes 1.00 hour of pharmacotherapy credit

Released: July 21, 2023

Expiration: July 20, 2024

CME/CE Information

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Risk Factors for CMV Development After HCT

The risk for CMV reactivation and disease generally is higher among patients who are CMV seropositive prior to allo-HCT, as the immunosuppressive aspects of the HCT process trigger latent CMV to reactivate. Recipient seropositivity is the most important predictor of post-transplantation CMV risk, and without prophylaxis, up to 80% of seropositive patients may develop CMV reactivation after transplantation.1,7 

All patients should be tested for latent CMV by serology using immunoglobulin G (IgG) prior to transplant.7 CMV status is classified as a primary infection, active infection, seropositive, or reactivated as below:

  • Primary infection: new CMV infection in an individual previously seronegative for CMV
  • Seropositive: Latent infection defined as presence of CMV-specific IgG in the absence of active viral replication7,11 
  • Reactivation: Development of detectable virus in blood after a period of latent seropositivity; reactivation is not the equivalent of primary CMV infection7

Risk factors for CMV infection or reactivation after transplant include low lymphocytes count. Presence of CD4+ T-cells <50/mL at 3 months after transplant is a risk factor for development of late-onset CMV disease.6 Other factors that increase risk are listed in Table  2.7

Table 2. Risk Factors for CMV Infection and Disease After Allo-HCT7

Which of these is an important risk factor for CMV reactivation in the first 30 days after allo-HCT?

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