CMV

CMV

AIDS Treatment Update, No. 44, August 1996
Edward King

Two studies found that measuring CMV levels in the blood (CMV viraemia) using a PCR test could provide an indication of which people may benefit most from anti-CMV drugs. A study at the Royal Free Hospital found that among 80 people with CD4 counts below 50, those who developed detectable blood levels of CMV, indicating that the virus is actively reproducing, were nearly seven times more likely to develop CMV disease. The average time between the appearance of CMV in the blood and the development of CMV symptoms was less than three months. No CMV disease was seen among people with negative CMV PCR test results (Th.A.394).

An American study confirmed the association between CMV viraemia and an increased risk of CMV disease, and also studied the effects of anti-CMV drugs. It found that among people with CMV viraemia, treatment with oral ganciclovir was only effective at reducing the risk of CMV disease in those with relatively low CMV levels (less than 50,000 copies/ml). In people with higher levels of CMV viraemia, oral ganciclovir appeared to be unable to prevent CMV disease. The researchers suggested that CMV prophylaxis should be offered to be people with low level CMV viraemia, while those with high level viraemia should be given 'pre-emptive therapy' with intravenous CMV treatment drugs (Th.B.302).

Another study compared the effectiveness of various forms of maintenance therapy, designed to delay a recurrence of CMV in people who have previously had an episode of CMV successfully treated. It found that intravenous ganciclovir delayed relapses for significantly longer than oral ganciclovir at the currently recommended dose of 3 g/day. However, higher doses of oral ganciclovir (4.5 or 6 g/day) seemed to approach the effectiveness of intravenous ganciclovir (Th.B.305).

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