Adenovirus Prophylaxis

Adenovirus Prophylaxis – Treatment Options

Introduction
Adenoviruses are double-stranded DNA viruses that typically cause self-limited respiratory tract infections, gastroenteritis, or conjunctivitis in healthy individuals. However, in immunocompromised patients (such as hematopoietic stem cell transplant or solid organ transplant recipients), adenovirus infection can progress to disseminated disease with high morbidity and mortality. At present, no universally accepted antiviral prophylaxis exists, but several preventive strategies and investigational approaches are employed in high-risk populations.

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1. General Preventive Measures

• Infection control practices:

  • Strict hand hygiene and use of alcohol-based sanitizers.

  • Contact precautions and environmental disinfection in hospital settings.

  • Avoidance of exposure to infected individuals, especially in transplant units.

• Vaccination (military use):

  • Oral live adenovirus type 4 and 7 vaccines are licensed for U.S. military personnel but not available to the general public.

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2. Pharmacological Approaches (Investigational/High-Risk Use)

• Antiviral agents (not approved for routine prophylaxis):

  • Cidofovir: Limited use due to nephrotoxicity; sometimes applied in high-risk transplant patients.

  • Brincidofovir (CMX001): An oral lipid conjugate of cidofovir with less renal toxicity, studied in clinical trials for prevention and treatment of adenovirus in immunocompromised patients.

  • Evidence is still emerging, and prophylactic use remains largely experimental.

• Intravenous immunoglobulin (IVIG):

  • Sometimes used as adjunctive therapy in immunocompromised hosts, though benefit is not well-established.

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3. Risk-Adapted Monitoring (“Pre-emptive Therapy”)

• PCR-based surveillance:

  • Regular monitoring of adenoviral DNA in blood, stool, or urine in transplant recipients.

  • Rising viral loads can trigger early initiation of antivirals before symptomatic disease develops.

• Adoptive T-cell therapy:

  • Donor-derived or third-party adenovirus-specific T cells have shown promise in preventing or controlling adenovirus in severely immunocompromised patients.

  • Currently limited to specialized centers.

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4. Lifestyle and Supportive Prevention

• Hydration and renal monitoring if nephrotoxic antivirals are used.

• Avoidance of unnecessary immunosuppression to reduce infection risk when possible.

• Nutritional and general immune support for transplant recipients and children.

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5. Multidisciplinary Care

• Infectious disease specialists: For risk stratification, antiviral decisions, and infection control.

• Transplant teams: For pre-emptive monitoring and immunosuppression adjustments.

• Virology labs: For PCR-based surveillance of adenoviral load.

• Immunotherapy experts: For adoptive T-cell approaches in refractory or high-risk cases.