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Review of Intravesicular Cidofovir for BK Virus Hemorrhagic Cystitis

  • Transplant/Immunocompromised Hosts (M Morales, Section Editor)
  • Published:
Current Treatment Options in Infectious Diseases Aims and scope Submit manuscript

Abstract

Purpose of Review

BK virus (BKV) reactivation in immunosuppressed patients, specifically in patients following allogeneic hematopoietic stem cell transplant, can result in hemorrhagic cystitis (HC). The mainstay of treatment to date has been a reduction of immunosuppression and symptom management; the utility of antiviral therapy has been uncertain. Several recent studies have reported the outcomes of intravesicular instillation of the antiviral agent cidofovir for treating this infection. This paper seeks to summarize the current literature on intravesicular cidofovir treatment for BKV-induced hemorrhagic cystitis (BKV-HC).

Recent Findings

The literature review identified 116 patients, both adults and children, in 17 studies, who received intravesicular cidofovir for the treatment of BKV-HC. Complete clinical response was observed in 72% (58/81) of adults and 74% (26/35) of children across the reported studies. No permanent systemic toxicities were reported with intravesicular cidofovir, in contrast with intravenous use, which was associated with significant nephrotoxicity. However, bladder pain and spasms after instillation of CDV were reported by 20–50% of patients across the various studies.

Summary

Intravesicular cidofovir shows promise in treating BKV-HC with minimal reported toxicity. However, a majority of reports are retrospective case studies and are limited by small sample sizes and no control groups. Further investigation through randomized controlled trials is warranted to guide the use of intravesicular cidofovir for this common post-transplant complication.

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  1. University of Maryland Medical Center, 22. S. Greene St, Baltimore, MD, 21201, USA

    Danica Palacio MD

  2. University of Maryland School of Medicine, Baltimore, MD, USA

    Katya Prakash MD & David J. Riedel MD, MPH

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Palacio, D., Prakash, K. & Riedel, D.J. Review of Intravesicular Cidofovir for BK Virus Hemorrhagic Cystitis. Curr Treat Options Infect Dis 13, 100–110 (2021). https://doi.org/10.1007/s40506-021-00251-y

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