200.2 📚 國考版

200.2.0.1 必背 — CMV in HIV

• CD4 < 50 retinitis (“pizza pie” fundus)
• CD4 < 100 colitis
• Esophagitis (linear ulcers vs Candida vs HSV)
• Treatment: valganciclovir + ART

200.2.0.2 必背 — CMV in Transplant

• D+/R- highest risk
• Prophylaxis: valganciclovir or letermovir
• HSCT prophylaxis: letermovir (no marrow toxicity)
• D+/R- SOT: prophylaxis × 100-200d

200.2.0.3 必背 — Congenital CMV

• #1 infectious cause of birth defects
• #1 non-genetic cause of sensorineural hearing loss
• Newborn urine/saliva PCR diagnostic
• Valganciclovir × 6 mo for symptomatic (Kimberlin)

200.2.0.4 必背 — CMV Drugs

Drug	Mech	Toxicity
Ganciclovir / Valganciclovir	UL97 kinase	Bone marrow suppression
Foscarnet	Direct polymerase	Nephro + electrolyte
Cidofovir	Polymerase	Severe nephrotoxic
Letermovir	Terminase	No marrow toxicity
Maribavir	UL97 kinase (different)	Dysgeusia

200.2.0.5 必背 — Owl’s Eye Inclusion

• Intranuclear, epithelial cells
• IHC confirms CMV
• Tissue diagnostic finding

200.2.0.6 必背 — Letermovir Game Changer

• HSCT prophylaxis × 100 days
• No myelo toxicity (unique)
• 60% reduction CMV infection

200.2.0.7 必背 — Maribavir

• Refractory/resistant CMV
• 2021 FDA
• Dysgeusia prominent
• Different mechanism than ganciclovir

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