Unselected intramuscular (IM) and intravenous (
IV) immunoglobulins, as well as virus-specific hyperimmune
globulins, occupy important roles as
immunotherapy for
viral infections. Standard IM
immunoglobulins may be utilised in selected, susceptible patients for the prevention of
hepatitis A and
measles. Hyperimmune
globulins to varicella zoster virus (VZV), hepatitis B virus and
rabies have established indications for use as post-exposure prophylaxis. Cytomegalovirus (CMV) hyperimmune
globulin has an indication for the prevention of primary CMV-associated disease in
kidney transplantation and has been shown to decrease severe CMV-associated disease in
liver transplantation. More recently, respiratory syncytial virus (RSV) hyperimmune
globulin has been developed and is being utilised to prevent RSV disease in high risk infants and children during months of maximum risk for
RSV infection. Unselected
IV immunoglobulins (
IVIg) have proven beneficial in preventing CMV-associated disease and
graft-versus-host-disease in allogeneic bone marrow transplant recipients. In addition,
IVIg plus
ganciclovir is effective
therapy for established CMV disease in both bone marrow and solid
organ transplantation.
IVIg for chronic anaemia associated with
parvovirus B19 infection is gaining acceptance, as is the use of
IVIg and intraventricular
immunoglobulin for chronic
meningoencephalitis associated with agammaglobulinaemia.
Immunotherapy for the prevention or treatment of several other
viral infections has been explored, but without clear conclusions. The use of human immunodeficiency virus (HIV) hyperimmune
globulins in HIV-infected patients has yielded inconsistent results and the role of such
therapy in the era of
highly active antiretroviral therapy is uncertain. Oral
immunoglobulins appear successful for rotaviral
infections, but their exact use requires further clarification. Other immunotherapeutic modalities, such as
monoclonal antibodies against CMV, RSV and HIV, have been developed but these agents have not undergone extensive clinical evaluation.