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id.cytomegalovirus-end-organ.v1PRODUCTION
id.cytomegalovirus-end-organ.v1

CMV end-organ disease (pneumonia / colitis / retinitis / hepatitis / encephalitis) — Kotton Transplantation 2018 PMID 29596116 + Ljungman CID 2024 PMID 39041385 + Avery SOLSTICE CID 2022 PMID 34864943

infectious_diseaseacutesubacuteadult
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12/12 authored

Canonical 12-phase frame with authored status for this dossier.

Current phase

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Detailed

Adult acute end-organ CMV in transplant (SOT / HSCT) and uncontrolled HIV — pneumonia, colitis, retinitis, hepatitis, encephalitis. Distinct from `id.cmv-immunocompromised.core.v1` (umbrella for viremia surveillance + pre-emptive + letermovir prophylaxis + congenital); routes BACK to umbrella for prophylaxis + longitudinal serostatus framing (Kotton Transplantation 2018 PMID 29596116; Ljungman CID 2024 PMID 39041385)

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immunocompromise substrate + acute end-organ scope confirmed

Patient inputs (13)

Defines CMV end-organ risk profile — HSCT (allogeneic > autologous) vs SOT (lung > heart > liver-pancreas > kidney; D+/R- highest) vs advanced HIV (CD4 < 50 for retinitis) vs iatrogenic biologic / steroid; drives empiric coverage + resistance suspicion + IS reduction coordination (Kotton Transplantation 2018 PMID 29596116; Ljungman CID 2024 PMID 39041385)

Calcineurin (tacrolimus / cyclosporine), mTOR (sirolimus / everolimus), anti-metabolite (MMF / azathioprine — additive marrow suppression with ganciclovir), steroid dose, biologic (alemtuzumab, ATG, rituximab, anti-TNF) — drives net state of immunosuppression + reduction coordination (Kotton Transplantation 2018 PMID 29596116)

Quantitative CMV PCR (WHO IU/mL preferred) — diagnostic anchor for tissue-invasive disease combined with organ-specific syndrome; LR+ ~ 10 for tissue-invasive when > 10,000 IU/mL; drives induction vs salvage decision (Ljungman CID 2017 PMID 27682069; Kotton Transplantation 2018 PMID 29596116)

Ganciclovir myelosuppression (neutropenia + thrombocytopenia) baseline + weekly monitoring; G-CSF rescue if severe ANC drop; baseline drives marrow-suppressive salvage choice (Kotton Transplantation 2018 PMID 29596116)

Ganciclovir + valganciclovir + foscarnet + cidofovir ALL require renal dose adjustment; foscarnet + cidofovir nephrotoxicity demand baseline + serial creatinine; CrCl < 70 starts dose-reduction (FDA labels; Kotton Transplantation 2018 PMID 29596116)

CMV encephalitis / ventriculitis — periventricular / subependymal enhancement; CSF PCR confirms; ddx HHV-6 (post-HSCT classic), HSV, autoimmune limbic encephalitis (DHHS 2024 OI)

Time-from-transplant defines CMV window (peak 30-100 d post-transplant); HSCT pre-engraftment vs post-engraftment GVHD differs; SOT D+/R- highest risk window (Kotton Transplantation 2018 PMID 29596116)

HIV-CMV substrate — retinitis classic at CD4 < 50; end-organ disease at CD4 < 100; ART optimization + IRIS-watch decisions hinge on CD4 + viral load (DHHS 2024 OI)

CMV hepatitis baseline + monitoring; rule out rejection in SOT (biopsy required for differentiation); ganciclovir hepatotoxicity surveillance (Kotton Transplantation 2018 PMID 29596116)

CMV pneumonia — diffuse interstitial / ground-glass infiltrate in HSCT; ddx PCP / aspergillosis / drug pneumonitis / pulmonary edema (ASBMT/IDSA HSCT; Kotton Transplantation 2018 PMID 29596116)

CMV retinitis "pizza-pie" hemorrhages + exudate along vascular arcades; zone 1 (foveal-threatening) vs zone 2/3; emergent ophtho at CD4 < 50 (DHHS 2024 OI)

CMV encephalitis with mass effect / herniation features escalates to ICU + neurosurgery; informs steroid use + ICP management (DHHS 2024 OI)

Drug-allergy + DDI panel (cidofovir + probenecid sulfa cross-reactivity; foscarnet + nephrotoxins; ganciclovir/valganciclovir + myelosuppressives) (FDA labels)

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Severity triggers (10)

10 need judgement
  • informationallife_threateningcmv_pneumonia_in_hsct_life_threatening
    CMV pneumonia in HSCT recipient (allogeneic > autologous) — diffuse interstitial / ground-glass infiltrate + hypoxia + CMV PCR positive ± BAL cytopathology / PCR — very high historic mortality without aggressive therapy
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateningcmv_retinitis_zone_1_vision_threatening
    CMV retinitis zone 1 (foveal-threatening) — "pizza-pie" hemorrhages + exudate along vascular arcades + foveal involvement at CD4 < 50 or transplant recipient — irreversible vision loss if delayed
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateningcmv_encephalitis_or_ventriculitis_life_threatening
    CMV encephalitis / ventriculitis — AMS + focal deficit + CSF PCR positive for CMV + MRI showing periventricular / subependymal enhancement — high mortality without aggressive therapy; minimum 6 wk induction
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateningseptic_shock_with_cmv_end_organ
    CMV end-organ disease (typically pneumonia or disseminated) + septic shock features (hypotension on adequate fluids + lactate > 2 + vasopressor requirement; Sepsis-3 Singer JAMA 2016; SSC 2026)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverecmv_colitis_with_severe_diarrhea_or_gi_bleeding
    CMV colitis — severe diarrhea ± hematochezia + abdominal pain in HSCT / SOT / advanced HIV + positive CMV PCR — endoscopy + biopsy "owl-eye" intranuclear inclusions + IHC
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverecmv_hepatitis_in_sot_vs_rejection_dilemma
    CMV hepatitis in SOT (especially liver transplant) — transaminitis + positive CMV PCR — biopsy required to distinguish from acute cellular rejection (which may co-exist)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevererefractory_or_resistant_cmv_end_organ
    Refractory / resistant CMV end-organ disease per Ljungman CID 2024 PMID 39041385 — persistent viremia > 1,000 IU/mL ≥ 2 wk on appropriate ganciclovir/valganciclovir with adherence + adequate exposure; UL97 most common, UL54 less common with cross-class resistance
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevereganciclovir_severe_marrow_suppression
    Severe pancytopenia on ganciclovir / valganciclovir induction despite G-CSF rescue — ANC < 500 OR platelet < 25 OR transfusion-dependent — requires switch to non-marrow-suppressive salvage
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverefoscarnet_aki_or_severe_electrolyte_derangement
    AKI from foscarnet (creatinine doubling or > 2 mg/dL absolute rise) OR severe symptomatic hypocalcemia (Trousseau, Chvostek, tetany, QTc prolongation) / hypomagnesemia / hypokalemia / hyperphosphatemia
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevereiris_post_art_in_cmv_retinitis_end_organ
    IRIS in CMV retinitis on ART start — paradoxical worsening 2-6 wk post-ART with new inflammatory features (uveitis, vitreitis, retinal vasculitis, macular edema)
    Trigger could not be auto-evaluated — needs clinician judgement.

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Recommended regimen

CMV end-organ induction — non-CNS, non-marrow-suppressive (valganciclovir / IV ganciclovir; salvage maribavir for refractory/resistant) (Kotton Transplantation 2018 PMID 29596116; Avery SOLSTICE CID 2022 PMID 34864943; Ljungman CID 2024 PMID 39041385)
axis: cmv_end_organ_induction_non_cnsstep 1 - Step 1 — Valganciclovir 900 mg PO BID OR IV ganciclovir 5 mg/kg q12h × 14-21 d (non-CNS first-line; Kotton Transplantation 2018 PMID 29596116)
Selected step "Step 1 — Valganciclovir 900 mg PO BID OR IV ganciclovir 5 mg/kg q12h × 14-21 d (non-CNS first-line; Kotton Transplantation 2018 PMID 29596116)" — Confirmed CMV end-organ disease (pneumonia non-HSCT, colitis, retinitis non-foveal, hepatitis, esophagitis tissue-invasive) — non-CNS, ganciclovir-sensitive (no resistance suspected), oral absorption intact (PO route) or NPO / GI malabsorption (IV)
  • valganciclovir
    first line
    nucleoside_analog_prodrug
    900 mg PO BID × 14-21 d induction → 900 mg PO daily maintenance • PO • BID induction → daily maintenance (max: 900 mg BID)
    triggers: end_organ_cmv_non_cns, oral_absorption_intact
    Kotton Transplantation 2018 PMID 29596116 — bioequivalent to IV ganciclovir at 900 mg PO BID per AUC; high oral bioavailability ~ 60%; renal dose adjustment required (CrCl 40-59 → 450 mg BID; CrCl 25-39 → 450 mg daily; CrCl 10-24 → 450 mg q48h)
    rxcui 275891
  • ganciclovir
    first line
    nucleoside_analog
    5 mg/kg IV q12h × 14-21 d (induction) → step down to valganciclovir 900 mg PO BID when stable + tolerating PO • IV • q12h induction (max: 5 mg/kg q12h)
    triggers: end_organ_cmv_non_cns, gi_malabsorption_or_NPO, severe_disease_or_high_viral_load
    Kotton Transplantation 2018 PMID 29596116 — IV induction for severe / GI malabsorption / NPO; renal dose adjustment; CBC monitoring q week (myelosuppression — neutropenia + thrombocytopenia); G-CSF rescue if severe ANC drop
    rxcui 4678

outpatient playbook — drug actions (3)

  1. 1. valganciclovir 900 mg PO daily maintenance
    rxcui 275891
    900 mg PO daily • PO • daily
    trigger: Post-induction secondary prophylaxis until immune recovery
    Kotton Transplantation 2018 PMID 29596116
  2. 2. ART optimization (HIV) — defer ART ~ 2 wk after retinitis induction
    per HIV regimen • PO • per regimen
    trigger: HIV-ART-naive with retinitis OR ART optimization needed (DHHS 2024 OI)
    Reduces IRIS severity; continue treating retinitis through ART start; ophtho follow-up 2-6 wk post-ART for IRIS-watch
  3. 3. restart pre-admission chronic regimen
    per patient baseline • per agent • per agent
    trigger: Stable post-discharge, no contraindication
    Avoid medication-list drift; reconcile any holds (e.g., MMF held during marrow suppression) — restart per primary team

Auto-drafted A&P note

outpatient

Subjective

- Possible entry pathways: Dyspnea + fever + hypoxia + diffuse interstitial / ground-glass infiltrate in HSCT recipient — CMV pneumonia is the life-threatening end-organ phenotype (ASBMT/IDSA HSCT; Ljungman CID 2024 PMID 39041385); Severe diarrhea ± hematochezia + abdominal pain in SOT / HSCT / advanced HIV — CMV colitis (endoscopy + biopsy "owl-eye" inclusions + IHC) (Kotton Transplantation 2018 PMID 29596116); New floaters / scotomata / blurred vision in HIV CD4 < 50 or transplant recipient — emergent ophthalmology for CMV retinitis (dilated fundoscopy: "pizza-pie" hemorrhages along vascular arcades) (DHHS 2024 OI).

Objective

- No vitals, labs, or imaging entered for this encounter.

Assessment

**CMV end-organ disease (pneumonia / colitis / retinitis / hepatitis / encephalitis) — Kotton Transplantation 2018 PMID 29596116 + Ljungman CID 2024 PMID 39041385 + Avery SOLSTICE CID 2022 PMID 34864943** (id.cytomegalovirus-end-organ.v1).
Phenotype framing: CMV pneumonia vs PCP / invasive aspergillosis / drug-induced pneumonitis (mTOR — sirolimus / everolimus) / pulmonary edema; CMV colitis vs C. difficile / GVHD-GI / drug colitis / ischemic colitis; CMV retinitis vs HSV / VZV acute retinal necrosis / HIV retinopathy; CMV encephalitis vs HHV-6 (post-HSCT classic) / HSV / autoimmune limbic encephalitis / lymphoma; CMV hepatitis vs rejection (SOT — biopsy required) / drug-induced / viral hepatitis (Kotton Transplantation 2018 PMID 29596116; DHHS 2024 OI)
Scope: Adult acute end-organ CMV in transplant (SOT / HSCT) and uncontrolled HIV — pneumonia, colitis, retinitis, hepatitis, encephalitis. Distinct from `id.cmv-immunocompromised.core.v1` (umbrella for viremia surveillance + pre-emptive + letermovir prophylaxis + congenital); routes BACK to umbrella for prophylaxis + longitudinal serostatus framing (Kotton Transplantation 2018 PMID 29596116; Ljungman CID 2024 PMID 39041385)

No severity triggers fired against current inputs.

Plan

Regimen axis: **CMV end-organ induction — non-CNS, non-marrow-suppressive (valganciclovir / IV ganciclovir; salvage maribavir for refractory/resistant) (Kotton Transplantation 2018 PMID 29596116; Avery SOLSTICE CID 2022 PMID 34864943; Ljungman CID 2024 PMID 39041385)** — step "Step 1 — Valganciclovir 900 mg PO BID OR IV ganciclovir 5 mg/kg q12h × 14-21 d (non-CNS first-line; Kotton Transplantation 2018 PMID 29596116)".
1. valganciclovir 900 mg PO BID × 14-21 d induction → 900 mg PO daily maintenance PO BID induction → daily maintenance (nucleoside_analog_prodrug, first line) — Kotton Transplantation 2018 PMID 29596116 — bioequivalent to IV ganciclovir at 900 mg PO BID per AUC; high oral bioavailability ~ 60%; renal dose adjustment required (CrCl 40-59 → 450 mg BID; CrCl 25-39 → 450 mg daily; CrCl 10-24 → 450 mg q48h)
2. ganciclovir 5 mg/kg IV q12h × 14-21 d (induction) → step down to valganciclovir 900 mg PO BID when stable + tolerating PO IV q12h induction (nucleoside_analog, first line) — Kotton Transplantation 2018 PMID 29596116 — IV induction for severe / GI malabsorption / NPO; renal dose adjustment; CBC monitoring q week (myelosuppression — neutropenia + thrombocytopenia); G-CSF rescue if severe ANC drop

Setting playbook (outpatient) — Complete maintenance valganciclovir + secondary prophylaxis until immune recovery; ART optimization in HIV with IRIS-watch (defer ART by ~ 2 wk after retinitis induction); ophtho q 3 mo during retinitis secondary prophylaxis; route back to umbrella `id.cmv-immunocompromised.core.v1` for longitudinal D/R-driven decisions
3. valganciclovir 900 mg PO daily maintenance 900 mg PO daily PO daily — Post-induction secondary prophylaxis until immune recovery (Kotton Transplantation 2018 PMID 29596116)
4. ART optimization (HIV) — defer ART ~ 2 wk after retinitis induction per HIV regimen PO per regimen — HIV-ART-naive with retinitis OR ART optimization needed (DHHS 2024 OI) (Reduces IRIS severity; continue treating retinitis through ART start; ophtho follow-up 2-6 wk post-ART for IRIS-watch)
5. restart pre-admission chronic regimen per patient baseline per agent per agent — Stable post-discharge, no contraindication (Avoid medication-list drift; reconcile any holds (e.g., MMF held during marrow suppression) — restart per primary team)

Non-pharmacologic actions:
- Adherence counseling (resistance prevention) (Kotton Transplantation 2018 PMID 29596116)
- IRIS counseling (HIV) — paradoxical worsening 2-6 wk post-ART; ophtho follow-up (DHHS 2024 OI)
- Pregnancy counseling for transplant recipients planning pregnancy (FDA labels)
- Ophtho lifelong f/u after vision-threatening retinitis (DHHS 2024 OI)
- Route back to umbrella `id.cmv-immunocompromised.core.v1` for longitudinal D/R + universal-vs-pre-emptive surveillance + letermovir-prophylaxis-eligible HSCT

AVOID / contraindication checks:
- Ganciclovir valganciclovir renal dose adjust CrCl under 70 (Kotton Transplantation 2018 PMID 29596116; FDA labels)
- Foscarnet nephrotoxicity monitor creatinine q 2 3 d (Kotton Transplantation 2018 PMID 29596116; FDA label)
- Foscarnet electrolytes Ca Mg K PO4 monitor symptomatic hypocalcemia seizure risk (FDA label)
- Foscarnet IV NS prehydration 500 1000mL before each dose (FDA label)
- Ganciclovir myelosuppression CBC weekly and G CSF rescue (Kotton Transplantation 2018 PMID 29596116; FDA label)
- Ganciclovir valganciclovir teratogenicity pregnancy AVOID (FDA labels; Kotton Transplantation 2018 PMID 29596116)
- Cidofovir nephrotoxicity probenecid IV hydration mandatory (FDA Vistide label)
- Cidofovir contraindicated CrCl under 55 or proteinuria ge 2+ (FDA Vistide label)
- Maribavir CONTRAINDICATED CNS disease poor CSF penetration (Avery SOLSTICE CID 2022 PMID 34864943; FDA Livtencity label)
- Maribavir DDI CYP3A substrate monitor tacrolimus cyclosporine sirolimus (FDA Livtencity label)
- Letermovir NOT treatment of established end organ disease prophylaxis only (Marty NEJM 2017 PMID 29211658; FDA Prevymis label)
- Resistance genotyping UL97 UL54 if persistent viremia 2 weeks (Ljungman CID 2024 PMID 39041385)

Monitoring

Regimen monitoring:
- CMV PCR q 2 3 d during inpatient induction then weekly (Kotton Transplantation 2018 PMID 29596116)
- CBC weekly during ganciclovir induction myelosuppression (FDA label)
- Creatinine q 2 3 d during foscarnet or cidofovir induction (FDA labels)
- Electrolytes Ca Mg K PO4 q 2 3 d during foscarnet (FDA label)
- LFT weekly during ganciclovir induction (Kotton Transplantation 2018 PMID 29596116)
- Minimum duration 14 to 21 d for induction in tissue invasive disease (Kotton Transplantation 2018 PMID 29596116)
- Resistance genotyping if persistent viremia 2 weeks (Ljungman CID 2024 PMID 39041385)

Setting (outpatient) monitoring:
- CMV PCR monthly (Kotton Transplantation 2018 PMID 29596116)
- CBC + creatinine q 2-4 wk (FDA labels)
- CD4 + VL q 3-4 mo (HIV) (DHHS 2024 OI)
- Ophtho q 3 mo (retinitis history) (DHHS 2024 OI)

Follow-up plan: Step-down to maintenance valganciclovir post-induction; secondary prophylaxis until immune recovery (HIV: CD4 > 100 × 3-6 mo + VL suppressed; HSCT through immune-reconstitution; SOT per organ + IS); ART optimization in HIV (defer ART by ~ 2 wk after retinitis induction to reduce IRIS — DHHS 2024 OI); route BACK to umbrella `id.cmv-immunocompromised.core.v1` for longitudinal D/R-driven prophylaxis decisions (especially HSCT letermovir-completion or SOT universal-vs-pre-emptive surveillance); ophtho lifelong f/u after vision-threatening retinitis (Kotton Transplantation 2018 PMID 29596116; DHHS 2024 OI; Marty NEJM 2017 PMID 29211658 — prophylaxis-only role)
- Close-out criterion: secondary prophylaxis + ART + organ-specific surveillance plan documented; routed back to umbrella for longitudinal management

Monitoring phase: CMV PCR q 2-3 d during inpatient induction → weekly during step-down → monthly during secondary prophylaxis; CBC weekly during ganciclovir induction (myelosuppression) → daily on foscarnet; creatinine + electrolytes (Ca, Mg, K, PO4) q 2-3 d during foscarnet; LFT q week during ganciclovir; ophtho q 1-2 wk during retinitis induction → q 3 mo secondary prophylaxis; repeat HRCT + ABG q few days during pneumonia; repeat MRI at 2-4 wk for encephalitis (Kotton Transplantation 2018 PMID 29596116; DHHS 2024 OI)

Disposition

Current setting: outpatient — Complete maintenance valganciclovir + secondary prophylaxis until immune recovery; ART optimization in HIV with IRIS-watch (defer ART by ~ 2 wk after retinitis induction); ophtho q 3 mo during retinitis secondary prophylaxis; route back to umbrella `id.cmv-immunocompromised.core.v1` for longitudinal D/R-driven decisions

Disposition criteria:
- Discontinue secondary prophylaxis: HIV CD4 > 100 × 3-6 mo + VL suppressed (DHHS 2024 OI); HSCT through immune reconstitution per center; SOT per organ + IS duration (Kotton Transplantation 2018 PMID 29596116)
- Final transition back to umbrella `id.cmv-immunocompromised.core.v1` for longitudinal D/R + universal-vs-pre-emptive surveillance

Escalation triggers (move to higher acuity):
- Rising CMV PCR → reassess for new end-organ syndrome → re-route to inpatient induction (Axis 1 Step 1 or Step 2 salvage) (Kotton Transplantation 2018 PMID 29596116)
- New visual disturbance / floaters / scotomata → emergent ophtho for retinitis reactivation (DHHS 2024 OI)
- New respiratory / GI / neurologic symptoms → ED for re-induction
- IRIS post-ART → continue OI therapy + ART + steroid short course if severe (DHHS 2024 OI)

Earlier-Return Triggers

Return-precaution thresholds (watch for):
- [LIFE_THREATENING] CMV pneumonia in HSCT recipient (allogeneic > autologous) — diffuse interstitial / ground-glass infiltrate + hypoxia + CMV PCR positive ± BAL cytopathology / PCR — very high historic mortality without aggressive therapy
- [LIFE_THREATENING] CMV retinitis zone 1 (foveal-threatening) — "pizza-pie" hemorrhages + exudate along vascular arcades + foveal involvement at CD4 < 50 or transplant recipient — irreversible vision loss if delayed
- [LIFE_THREATENING] CMV encephalitis / ventriculitis — AMS + focal deficit + CSF PCR positive for CMV + MRI showing periventricular / subependymal enhancement — high mortality without aggressive therapy; minimum 6 wk induction

Citations

- Kotton CN et al, Transplantation 2018 PMID 29596116 (The Third International Consensus Guidelines on the Management of CMV in Solid-Organ Transplantation; AST-IDCOP consensus) + Ljungman P et al, Clin Infect Dis 2024 PMID 39041385 (Consensus Definitions of CMV Infection and Disease in Transplant Patients Including Resistant and Refractory CMV) + Ljungman P et al, Clin Infect Dis 2017 PMID 27682069 (Definitions of CMV Infection and Disease) + Avery RK et al, Clin Infect Dis 2022 PMID 34864943 (SOLSTICE Phase 3 maribavir for refractory/resistant CMV) + Marty FM et al, NEJM 2017 PMID 29211658 (letermovir prophylaxis post-HSCT — prophylaxis-only, NOT treatment) + DHHS 2024 OI Guidelines (clinicalinfo.hiv.gov web-anchored) [PMID:29596116](https://pubmed.ncbi.nlm.nih.gov/29596116/)
- Cited evidence (PMID 39041385) [PMID:39041385](https://pubmed.ncbi.nlm.nih.gov/39041385/)
- Cited evidence (PMID 27682069) [PMID:27682069](https://pubmed.ncbi.nlm.nih.gov/27682069/)
- Cited evidence (PMID 34864943) [PMID:34864943](https://pubmed.ncbi.nlm.nih.gov/34864943/)
- Cited evidence (PMID 29211658) [PMID:29211658](https://pubmed.ncbi.nlm.nih.gov/29211658/)

Last reconciled with current guidelines: 2026-05-26.
References
  • Kotton CN et al, Transplantation 2018 PMID 29596116 (The Third International Consensus Guidelines on the Management of CMV in Solid-Organ Transplantation; AST-IDCOP consensus) + Ljungman P et al, Clin Infect Dis 2024 PMID 39041385 (Consensus Definitions of CMV Infection and Disease in Transplant Patients Including Resistant and Refractory CMV) + Ljungman P et al, Clin Infect Dis 2017 PMID 27682069 (Definitions of CMV Infection and Disease) + Avery RK et al, Clin Infect Dis 2022 PMID 34864943 (SOLSTICE Phase 3 maribavir for refractory/resistant CMV) + Marty FM et al, NEJM 2017 PMID 29211658 (letermovir prophylaxis post-HSCT — prophylaxis-only, NOT treatment) + DHHS 2024 OI Guidelines (clinicalinfo.hiv.gov web-anchored) — PMID:29596116
  • Cited evidence (PMID 39041385) — PMID:39041385
  • Cited evidence (PMID 27682069) — PMID:27682069
  • Cited evidence (PMID 34864943) — PMID:34864943
  • Cited evidence (PMID 29211658) — PMID:29211658