Leruez-Ville Marianne

Biography

Marianne Leruez-Ville is a MD specialized in Clinical Virology and holds a PHD in Virology.

She is a consultant in clinical Virology and at the head of the Microbiology laboratory of Necker-Hospital for sick children in Paris, France. She is the director of the congenital CMV laboratory within the French National Reference Center for Herpes Viruses and she belongs to a research group focusing on fetal abnormalities and their treatment (EA 7328, Imagine Institute, University Paris Cité).  Her main research interest is clinical virology in relation to congenital CMV infection.

Keynote Lecture Abstract

Antiviral treatment in pregnancy

Several antivirals against CMV (ganciclovir, cidofovir and foscarnet) are used to treat severe infections in immunocompromised patients. These drugs, which are nucleotide antagonists, have potential teratogenic effects and well-known toxicity (haematological and renal) which limit their use during pregnancy. Valacyclovir is not the best anti-CMV drug but, at high doses, it was effective in preventing CMV disease in transplant patients and very reassuring pharmacovigilance data in pregnancy are available.

A Phase II open label trial using valacyclovir 8g/day to treat infected fetuses reported a significantly increased proportion of asymptomatic neonates with treatment when compare to an historical cohort. Only rare and mild side effects were reported. This study suggested a plausibility of the efficacy of prenatal valacyclovir treatment in infected fetuses as well as the safety of its use in pregnancy.

An Israeli team conducted a double-blind, placebo-controlled trial that demonstrated the efficacy of valacyclovir 8g/day on preventing vertical transmission of CMV in 100 pregnant women with a first trimester primary infection (PI) (9). Valacyclovir administered from diagnosis of PI to amniocentesis allowed a 70% reduction of vertical transmission compare to placebo. Enhanced efficacy of valacyclovir was reported when it was promptly initiated after the diagnosis of PI. A confirmatory case-control study from our group including 65 pregnancies treated with valacyclovir with appropriately matched controls showed a similar 70% decrease in vertical transmission (10). Presently, 121 women with PI in the first trimester have now been treated with valacyclovir in our centre, the results of this management will be described.