ANTIVIRAL IMMUNOTHERAPY - A REVIEW OF CURRENT STATUS

Unselected intramuscular (IM) and intravenous (IV) immunoglobulins, as well as virus-specific hyperimmune globulins, occupy important roles as immu notherapy for viral infections. Standard IM immunoglobulins ma y be utilised in selected, susceptible patients for the prevention of hepatitis A and measles. Hyperimmune globulins to varicella tester vir us (VZV), hepatitis B virus and rabies have established indications fo r use as post-exposure prophylaxis. Cytomegalovirus (CMV) hyperimmune globulin has an indication for the prevention of primary CMV-associate d disease in kidney transplantation and has been shown to decrease sev ere CMV-associated disease in liver transplantation. More recently, re spiratory syncytial virus (RSV) hyperimmune globulin has been develope d and is being utilised to prevent RSV disease in high risk infants an d children during months of maximum risk for RSV infection. Unselected IV immunoglobulins (IVIg) have proven beneficial in preventing CMV-as sociated disease and graft-versus-host-disease in allogeneic bone marr ow transplant recipients. In addition, IVIg plus ganciclovir is effect ive therapy for established CMV disease in both bone marrow and solid organ transplantation. IVIg for chronic anaemia associated with parvov irus B19 infection is gaining acceptance, as is the use of IVIg and in traventricular immunoglobulin for chronic meningoencephalitis associat ed with agammaglobulinaemia. Immunotherapy for the prevention or treat ment of several other viral infections has been explored, but without clear conclusions. The use of human immunodeficiency virus (HIV) hyper immune globulins in HIV-infected patients has yielded inconsistent res ults and the role of such therapy in the era of highly active antiretr oviral therapy is uncertain. Oral immunoglobulins appear successful fo r rotaviral infections, but their exact use requires further clarifica tion. Other immunotherapeutic modalities, such as monoclonal antibodie s against CMV, RSV and HIV, have been developed but these agents have not undergone extensive clinical evaluation.