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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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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