Important note: Information in this article was accurate in 1992. The state of the art may have changed since the publication date.
CMV RETINITIS IN THE AIDS PATIENT
AIDS Updates; 3(3):1-12 1990. Unique Identifier : AIDSLINE ICDB/92669953 Resta S; Wolitz R; Merigan TC; Div. of Infectious Diseases, Stanford Univ., Stanford, CA
Abstract:
Human cytomegalovirus (HCMV) belongs to the herpes viruses and shares with the other members of this family of viruses some basic characteristics. CMV retinitis in the patient (pt) with AIDS is reviewed, including ocular manifestations in AIDS, clinical manifestation and treatment of HCMV retinopathy, and future research directions. HCMV infection is common and mostly asymptomatic (more than 90% of cases) in adults, among whom more than 50% appear to be seropositive by age 50 yr. More than 90% of pts with AIDS show evidence of active HCMV infection, and almost one-third of them will experience severe clinical manifestations related to this virus during the course of their underlying disease. In pts with AIDS, particularly in the homosexual/bisexual group, HCMV disease is due to reactivation of latent virus, and less commonly to reinfection, and will develop into a variety of clinical syndromes, when a specific organ is involved, or be overwhelming and disseminated. Great progress in antiviral therapy has been made with the synthesis of purine and pyrimidine analogs for the treatment of infections caused by DNA viruses. Most of the agents tried for HCMV therapy over the past 20 yr, however, have been relatively unsuccessful. FIAC [1-(2'-deoxy-2'-fluoro-beta-D-arabinofuranosyl)-5-iodocytosine] has shown greater activity in vitro against CMV compared to acyclovir (ACV) and BVDU. 9-[1,3-Dihydroxy-2-propoxymethyl]guanine (DHPG) shows in vitro activity against HCMV and herpes simplex virus (HSV)-1 and -2 and, to a lesser degree, against Epstein-Barr virus (EBV), varicella zoster virus, HSV-6, and human adenovirus. It is considerably more potent than ACV against CMV and equally potent against HSV. DHPG is more active than any other nucleoside analog against CMV and inhibits the productive cycle, but not the latent phase, of EBV in a way similar to ACV. Synergy of DHPG with foscarnet (phosphonoformic acid, PFA) and interferon also has been demonstrated in vitro. Numerous studies have been conducted with DHPG in HCMV retinopathy. In all studies, some pts showed improvement or stabilized. Limited data reported in the literature demonstrate clinical efficacy of PFA in inducing stabilization or improvement of HCMV retinitis in immunocompromised pts and parallel improvement in the viral shedding data. (99 Refs)
Keywords: Acquired Immunodeficiency Syndrome/*COMPLICATIONS/DRUG THERAPY Antiviral Agents/THERAPEUTIC USE Cytomegalovirus Infections/DRUG THERAPY/*ETIOLOGY Diagnosis, Differential Fluorescein Angiography Human Opportunistic Infections/DRUG THERAPY/*ETIOLOGY Retina/PATHOLOGY Retinitis/DRUG THERAPY/*ETIOLOGY JOURNAL ARTICLE REVIEW 921230
M92C5382
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Important note: Information in this article was accurate in 1992. The state of the art may have changed since the publication date.
