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Pathogenesis of human cytomegalovirus in the immunocompromised host

Human cytomegalovirus (HCMV) is a herpesvirus that infects ~60% of adults in developed countries and more than 90% in developing countries. Usually, it is controlled by a vigorous immune response so that infections are asymptomatic or symptoms are mild. However, if the immune system is compromised,...

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Detalles Bibliográficos
Autores principales: Griffiths, Paul, Reeves, Matthew
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8223196/
https://www.ncbi.nlm.nih.gov/pubmed/34168328
http://dx.doi.org/10.1038/s41579-021-00582-z
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author Griffiths, Paul
Reeves, Matthew
author_facet Griffiths, Paul
Reeves, Matthew
author_sort Griffiths, Paul
collection PubMed
description Human cytomegalovirus (HCMV) is a herpesvirus that infects ~60% of adults in developed countries and more than 90% in developing countries. Usually, it is controlled by a vigorous immune response so that infections are asymptomatic or symptoms are mild. However, if the immune system is compromised, HCMV can replicate to high levels and cause serious end organ disease. Substantial progress is being made in understanding the natural history and pathogenesis of HCMV infection and disease in the immunocompromised host. Serial measures of viral load defined the dynamics of HCMV replication and are now used routinely to allow intervention with antiviral drugs in individual patients. They are also used as pharmacodynamic read-outs to evaluate prototype vaccines that may protect against HCMV replication and to define immune correlates of this protection. This novel information is informing the design of randomized controlled trials of new antiviral drugs and vaccines currently under evaluation. In this Review, we discuss immune responses to HCMV and countermeasures deployed by the virus, the establishment of latency and reactivation from it, exogenous reinfection with additional strains, pathogenesis, development of end organ disease, indirect effects of infection, immune correlates of control of replication, current treatment strategies and the evaluation of novel vaccine candidates.
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spelling pubmed-82231962021-06-25 Pathogenesis of human cytomegalovirus in the immunocompromised host Griffiths, Paul Reeves, Matthew Nat Rev Microbiol Review Article Human cytomegalovirus (HCMV) is a herpesvirus that infects ~60% of adults in developed countries and more than 90% in developing countries. Usually, it is controlled by a vigorous immune response so that infections are asymptomatic or symptoms are mild. However, if the immune system is compromised, HCMV can replicate to high levels and cause serious end organ disease. Substantial progress is being made in understanding the natural history and pathogenesis of HCMV infection and disease in the immunocompromised host. Serial measures of viral load defined the dynamics of HCMV replication and are now used routinely to allow intervention with antiviral drugs in individual patients. They are also used as pharmacodynamic read-outs to evaluate prototype vaccines that may protect against HCMV replication and to define immune correlates of this protection. This novel information is informing the design of randomized controlled trials of new antiviral drugs and vaccines currently under evaluation. In this Review, we discuss immune responses to HCMV and countermeasures deployed by the virus, the establishment of latency and reactivation from it, exogenous reinfection with additional strains, pathogenesis, development of end organ disease, indirect effects of infection, immune correlates of control of replication, current treatment strategies and the evaluation of novel vaccine candidates. Nature Publishing Group UK 2021-06-24 2021 /pmc/articles/PMC8223196/ /pubmed/34168328 http://dx.doi.org/10.1038/s41579-021-00582-z Text en © Springer Nature Limited 2021 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Review Article
Griffiths, Paul
Reeves, Matthew
Pathogenesis of human cytomegalovirus in the immunocompromised host
title Pathogenesis of human cytomegalovirus in the immunocompromised host
title_full Pathogenesis of human cytomegalovirus in the immunocompromised host
title_fullStr Pathogenesis of human cytomegalovirus in the immunocompromised host
title_full_unstemmed Pathogenesis of human cytomegalovirus in the immunocompromised host
title_short Pathogenesis of human cytomegalovirus in the immunocompromised host
title_sort pathogenesis of human cytomegalovirus in the immunocompromised host
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8223196/
https://www.ncbi.nlm.nih.gov/pubmed/34168328
http://dx.doi.org/10.1038/s41579-021-00582-z
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