Emerging treatments

CMV vaccines

Several candidate vaccines, including live attenuated, recombinant/chimeric viral vectors, recombinant subunits, or gene-based vaccines, are in pre-clinical and early-phase clinical development.[51] Phase II studies have reported reduction in cytomegalovirus (CMV) infection in pregnant women and transplant recipients who received the CMV glycoprotein B vaccine containing the MF59 adjuvant; a bivalent DNA vaccine reduced the occurrence and recurrence of CMV viraemia in CMV-seropositive, allogeneic haematopoeitic stem cell transplant recipients.[63][64][65]​​ However, in a phase II trial of CMV seronegative kidney transplant recipients receiving a kidney from a CMV seropositive donor, the bivalent DNA vaccine did not prevent episodes of CMV viraemia needing antivirals when compared with placebo.[66] A chimeric vaccine has been shown to reduce CMV viraemia in patients undergoing haematopoietic stem cell transplantation in a phase I study.[67]​ Additionally, the V160 vaccine (a replication-defective investigational CMV vaccine) elicited strong immune responses in CMV-seronegative women of child-bearing age exposed to young children, showing promise for effective CMV prevention. Despite not significantly reducing infections, it suggests potential in decreasing CMV transmission in high-risk groups.[68]

Adoptive T-cell therapies

The critical role of adaptive immunity in the control of cytomegalovirus (CMV) infection has led to clinical trials involving infusion of CMV-specific CD8+ T cells in patients with refractory and resistant CMV disease.[69]

Immune monitoring

Monitoring of CMV-specific CD4+ and CD8+ T-cell responses may be a promising way of refining prevention and treatment strategies.[70][71]​ For example, patients with strong cell-mediated immune responses could safely discontinue antivirals at an earlier stage. Interventional studies are ongoing. 

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