skip to main content

CMV Breakthrough on Prophylaxis — SCE Infectious Diseases MCQ

Instant feedback + full explanation. One question, done properly.

ModerateImmunocompromised HostCMV Breakthrough on ProphylaxisSCE Infectious Diseases

A 50-year-old man with a recent liver transplant is on Valganciclovir prophylaxis for CMV (D+/R-). At month 4 of prophylaxis, his CMV PCR becomes detectable at 2,500 copies/mL. He is asymptomatic. What is the most appropriate action?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Increase to treatment-dose Valganciclovir (900 mg BD) — breakthrough viraemia on prophylactic dosing requires dose escalation to treatment levels

Breakthrough CMV viraemia on prophylactic-dose Valganciclovir (900 mg OD) indicates inadequate viral suppression. The first step is escalation to treatment dose (900 mg BD, adjusted for renal function). Resistance testing (UL97/UL54 gene sequencing) should be sent to exclude Ganciclovir resistance, particularly if viraemia persists at treatment dose. Adequate drug exposure should be confirmed (adherence, renal-adjusted dosing). Switching to Foscarnet is reserved for confirmed Ganciclovir resistance. Adding Letermovir to Ganciclovir is not established practice.

Reference: NICE NG37 2016 – SOT: CMV; ECIL-7 2019 – CMV