Important note: Information in this article was accurate in 1997. The state of the art may have changed since the publication date.
Consequences for the management of cytomegalovirus.
AIDS. 1996 Nov;10 Suppl 1:S43-6. Unique Identifier : AIDSLINE MED/97125604 Katlama C; Groupe Hospitalier Pitie-Salpetriere, Paris, France.
Abstract:
BACKGROUND: Recent advances in the field of antiretroviral therapy have led to a new era where it is possible to effectively prolong the survival of HIV-infected patients. However, a corollary is the increasing prevalence of opportunistic infections, such as cytomegalovirus (CMV). CMV disease is associated with substantial morbidity, mortality, moral prejudice, impaired quality of life and cost. THE NATURAL HISTORY OF CMV INFECTION: The natural history of CMV infection consists of three phases: there is latent CMV infection with a low CMV viral load where, ideally, prophylactic treatment is indicated; then at the opposite end of the spectrum there is CMV visceral localization, associated with clinical symptoms and tissue injuries, where acute therapy is required. In between these two stages, there is reactivation of CMV, in the absence of clinical symptoms, characterized by a medium or high viral load. Early pre-emptive therapy is indicated at this stage. It is clearly very important to distinguish between these stages in order that the patient receives optimum therapy. PROPHYLAXIS AND PRE-EMPTIVE THERAPY: A recent large, placebo-controlled study has revealed the prophylactic efficacy of oral ganciclovir, with a significant reduction in the incidence of CMV disease after both 12 and 18 months. The fact that patients in this study who had reactivation of CMV virus experienced more limited benefits than those who did not have reactivation leads directly to the idea of pre-emptive therapy in those patients who are at high risk of developing the disease. Drugs used for pre-emptive therapy include foscarnet, ganciclovir and cidofovir; oral adefovir and lobucavir are also currently in development. CONCLUSIONS: The understanding of CMV infection and disease is entering a new phase. However, new drugs and new therapeutic regimens need to be evaluated and there is an urgent need for techniques to evaluate virological markers of infection and the efficacy of treatment.
Keywords: *AIDS-Related Opportunistic Infections/DRUG THERAPY *Cytomegalovirus Infections/COMPLICATIONS *Cytomegalovirus Infections/DRUG THERAPY 970630
M9761246
AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
Important note: Information in this article was accurate in 1997. The state of the art may have changed since the publication date.
