GANCICLOVIR THERAPY FOR CYTOMEGALOVIRUS-ASSOCIATED LIVER-DISEASE IN IMMUNOCOMPETENT OR IMMUNOCOMPROMISED CHILDREN

Ganciclovir therapy was given intravenously to 20 children with cytome galovirus (CMV)-associated liver disease, of whom 6 were immunocompete nt and 14 were immunocompromised (9 had AIDS and 5 had solid tumors). Immunocompetent children had isolated liver disease diagnosed at birth (4 children), or systemic congenital CMV infection including liver di sease (2 children). Ganciclovir was used following two regimens: A) 5 mg/kg twice daily for 8 to 86 days (mean 21); B) 7.5 mg/kg twice daily for 14 days followed by 10 mg/kg three times weekly for three months. CMV infection was diagnosed by viral isolation, detection of viral an tigens, and/or CMV DNA fi-om blood and urine. All immunocompetent chil dren had negative CMV culture and CMV DNA detection from blood and/or urine after 14 weeks of treatment. However, the three children who wer e treated with regimen B showed normal ALT levels at the end of the ma intenance course, whereas the children who received ganciclovir with r egimen A had normal ALT levels only after about 1 year. All children w ith tumors initiated regimen B, but only three, who had negative CMV d etection and markedly decreased ALT levels, received full treatment; o f the remaining two children, one recovered after only an initial cour se, and the other had therapy interrupted because of hepatic failure a nd died 9 days later. In contrast, the children with AIDS received sev eral ganciclovir courses for different periods at the lower dosage: th ey generally improved during treatment but did not recover completely, and five children died with active CMV infections. Based on our study , CMV-associated liver disease can be efficiently treated with gancicl ovir both in immunocompetent and immunodeficient children. However, a single ganciclovir course including a higher dosage and prolonged ther apy appeared to be more effective than several courses with lower dosa ges.