Cytomegalovirus infections in people with HIV.

Important note: Information in this article was accurate in 1994. The state of the art may have changed since the publication date.

Cytomegalovirus infections in people with HIV.

Annu Conf Australas Soc HIV Med. 1993 Oct 28-30;5:24 (abstract no. SPI-2). Unique Identifier : AIDSLINE ASHM5/94348942
van der Horst C; University of North Carolina.

Abstract: By the time of death up to 40% of HIV infected people will develop life or sight threatening CMV infections. With some rare exceptions most of these infections will occur when the CD4 count drops below 100 cells/mm3 and usually do not occur until the CD4 count is less than 50 for 12 months. Diagnosis requires direct examination (retinitis, esophageal ulcers, colitis, polyradiculomyelopathy), radiologic studies (MRI-encephalitis), biopsy (ulcers, colitis), culture/PCR (polyradiculomyelopathy/encephalitis), or other lab tests (cortisol level-adrenalitis). The treatment varies for each diagnosis with the most information available for retinitis. Both foscarnet and ganciclovir (GCV) are equally efficacious in treating retinitis with relapse usually occurring in 2 months. Several studies suggest that foscarnet may prolong life in HIV patients by an average of 4-5 months. This could be due to its direct anti-HIV effect or its bonemarrow sparing effect thus allowing concomittant use of anti-retrovirals. The dose for induction is ganciclovir 5 mg/kg twice each day or foscarnet 60 mg/kg three times each day. The length of induction is usually 2 weeks but should be determined by clinical response assessed by retinal exam. Both drugs should be adjusted for renal disease. Side effects of GCV include bone marrow toxicity and thus AZT should be stopped during induction. Foscarnet results in electrolyte disorders with nephrotoxicity, hypocalcemia, hypomagnesemia, and hypophosphatemia. Therapy for retinitis must be lifelong with maintainance dose of GCV 5 mg/kg daily for 7 days or 6-7 mg/kg daily for 5 days. Foscarnet's maintainance dose is 90-120 mg/kg 7 days each week. At the time of the second relapse on GCV serious consideration should be given to switching therapy to foscarnet as resistance develops over time to GCV.

Keywords: AIDS-Related Opportunistic Infections/DIAGNOSIS/*DRUG THERAPY Cytomegalovirus Infections/DIAGNOSIS/*DRUG THERAPY Cytomegalovirus Retinitis/DIAGNOSIS/DRUG THERAPY Dose-Response Relationship, Drug Drug Administration Schedule Drug Therapy, Combination Foscarnet/ADVERSE EFFECTS/*THERAPEUTIC USE Ganciclovir/ADVERSE EFFECTS/*THERAPEUTIC USE Human Zidovudine/ADVERSE EFFECTS/THERAPEUTIC USE ABSTRACT
941230
M94C4285

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