Third International Congress Drug Therapy in HIV Infection 3-7 November 1996 Glasgow, UK

CYTOMEGALOVIRUS (CMV) PROPHYLAXIS

Judith Feinberg
University of Cincinnati, Holmes Hospital, Eden & Bethesda Aves, Cincinnati, Ohio, USA 45267

Int Cong Drug Therapy HIV 1996 Nov 3-7;3:Abstract No. 5.2
AIDS 1996, Vol. 10 (Suppl. 2);S4

CMV end organ disease is a common complication of advanced HIV disease, occurring in 25-40% of patients (pts) with very low CD4+ cells. CMV retinitis, a necrotizing infection that ultimately results in atropy that may lead to visual loss, is the most common manifestation of CMV disease, accounting for 79-85% of CMV diagnoses in recent studies. Because current therapies for CMVi disease, whether systemic and/or intraocular, are imperfect,: lifelong, expensive and have significant adverse effects, prevention has been a highly sought-after goal. In two controlled, double-blind, randomized trials both oral ganddovir (GCV) and valaciclovir (VACV) have reduced the development of CMV disease in pts considered to be at high risk (CD4+ <100, CMV IgG+ or culture-+) with no evidence of end-organ disease at entry; the magnitude of the protective effect was a 50% and 33% reduction in disease rates respectively. Both agents exhibited an antiviral effect on recovery of CMV from cultures (primarily urine). [Although a 2^nd controlled oral GCV study failed to duplicate these results, important differences in study design and implementation may account for the discordance.] No clear survival advantage was seen. Significant adverse effects included: neutropenia and renal insufficiency (oral GCV); gastrointestinal complaints and renal insufficiency (VACV). Testing of stored samples obtained prospectively in these trials by CMV DNA PCR has advanced our understanding of pathogenesis. CMV viremia at study entry is prognostic for the later development of CMV disease. Viral load testing may enable us to identify pts at highest risk, so that prophylaxis can be targeted to that group.

Presenting author: Judith Feinberg

1996-11-03
5.2

Originally published in AIDS Volume 10, Supplement 2 and hosted with permission of the publisher Lippincott Williams & Wilkins, 250 Waterloo Road, London, SE1 8RD, UK. Tel: +44 (0)20 7981 0700 Fax: +44 (0) 7981 0701

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