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Cytomegalovirus Prevention Strategies: The Case for Prophylaxis

I read with interest the article by Sun, Wagener and Singh in the August American Journal of Transplantation (1). Dr. Singh and I have been publically debating the risks and benefits of a preemptive versus prophylactic strategy to prevent cytomegalovirus (CMV) infection and disease in solid organ transplants for a number of years (2–4). In several meta-analyses quoted in the article, the potential benefits of prophylaxis include a reduction in the indirect effects of CMV with improved survival, and a reduced incidence of opportunistic infections. Dr. Singh’s own data from her paper presented in a comparative 2 × 3 table below illustrate nicely the benefit of CMV prophylaxis over preemptive therapy.