What is the role of cytomegalovirus antiviral resistance testing in the workup of cytomegalovirus (CMV)?

Updated: Jul 07, 2021
  • Author: Ricardo Cedeno-Mendoza, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

If resistant CMV infection is suspected (refractory to IV ganciclovir or valganciclovir therapy), an alternative therapy should be used based on genetic resistance. UL54 mutation is associated with ganciclovir resistance and a cross-resistance with Cidofovir. UL97 mutation is also associated with ganciclovir resistance. If this is noted, Foscarnet is the recommended therapy. Letermovir could be an alternate option due to a different mechanism of action (however this is currently recommended only for prophylaxis). If low levels of resistance is suspected, higher doses of Ganciclovir could be used. [60]


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