Prophylaxis for CMV should not now replace pre-emptive therapy in solid organ transplantation.

Pre-emptive therapy (PET) initiated on the basis of HCMV positivity in the blood using sensitive methods such as PCR, nucleic acid sequence based amplification or antigenaemia offers several advantages for the management of HCMV infection. These include the ability to target antiviral drug therapy to those most at risk of future disease, minimising drug exposure and maximising cost-benefit. In addition, allowing limited replication to occur also provides immune stimulation which will be important for future control of HCMV replication. In contrast, prophylaxis is a high-cost strategy which exposes all patients to potentially toxic drugs, does not facilitate immune priming and leads to the development of late HCMV infection and disease in high-risk patients. Copyright 2001 John Wiley & Sons, Ltd.