Cytomegalovirus (CMV) infection remains a frequent complication in hematopoietic stem cell transplantation (HSCT) and solid organ transplantation (SOT) recipients. In addition to causing a variety of end-organ diseases, CMV infection is also associated with rejection after SOT and with graft versus host disease (GVHD) after HSCT, as well as with increased risk of secondary bacterial and fungal infections. Antiviral prophylaxis, more commonly used after SOT, is effective against direct and indirect effects of CMV infection, but may lead to overtreatment. Preemptive therapy, more commonly used after HSCT, is based on surveillance, and targets therapy to patients at highest risk. Several antiviral agents are currently available for CMV management; however, their use may be associated with myelosuppression and nephrotoxicity. Novel antiviral therapies with different mechanisms of action are in late-stage development and hold the promise of reducing CMV-related morbidity and mortality.
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The treatment of HCV has undergone a dramatic evolution in the last several years. Whereas traditional interferon-based therapy for HCV was limited by poor efficacy and a heavy burden of side effects, interferon-free antiviral regimens are now available, offering new options for patients and altering the approach to this serious disease. The rapid pace of drug research, development, and approval requires frequent updates to treatment guidelines and leaves many clinicians wondering when, in whom, and how to manage chronic HCV infection.