LAUSR

To the Editor: Biliary atresia (BA) is characterized by progressive inflammation and fibrosis of both the extrahepatic and intrahepatic bile ducts within 3 mo of life [1, 2]. Antiviral drugs such as ganciclovir or its oral prodrug valganciclovir have been in use for the treatment of congenital CMV infection, but no standard treatment protocol exist for CMV + ve BA [3, 4]. This study involves 22 CMV-positive and 33 CMV-negative patients. All CMV-positive patients were started on IV ganciclovir (6 mg/kg/dose BD), soon after the finding of a positive urinary PCR for CMV, which was followed by tab valganciclovir (16 mg/kg/day BD for 3 wk). Successful outcome following KPE was defined by clearance of jaundice (≤ 2 mg/dL) after 6 mo of surgery. CMV-positive BA infants were older at their first consultation than CMV-negative BA infants, and showed higher S. bilirubin, higher degree of inflammation, and fibrosis in comparison to CMV-negative BA (Supplementary Table S1). Jaundice clearance after 6 mo of surgery was 80% in the AVT-treated CMV-positive group, while it was 62% in the CMV-negative group (Supplementary File 2). However, we did not observe any significant difference in the overall survival between the two groups. These results suggest the positive outcome of AVT, providing hope to an otherwise dreary disease subset. For effective therapy and timely initiation of treatment in cases of CMV-associated BA, we need to refine our understanding of the etiology of this subset of disease. The treatment regime of using the antiviral drugs in both the preand postsurgical period seems to be a better option, as evident by the encouragingly high number of jaundice clearance rates in our series. Therefore, there is an urgent need to find an effective treatment targeting the virus to keep this disease in check, if not cure it.