(BALA) Preventing and Treating CMV Retinitis

(BALA) Preventing and Treating CMV Retinitis

BEING ALIVE: February 1995
Mark Katz, MD, and reported by Jim Stoecker

CMV retinitis remains one of the most common opportunistic infections in late stage AIDS. The big news in treating this OI is the recent FDA approval of oral ganciclovir for maintenance therapy. It should be noted that the oral form of ganciclovir is not for initial therapy; IV ganciclovir should still be used for the first two to three weeks of treatment. Then the much less cumbersome oral therapy can begin. Studies have shown that the oral form of ganciclovir is comparable to the IV formin delaying progression of CMV retinitis.

Although not approved for prophylaxis, some may want to use oral ganciclovir to prevent the onset of CMV retinitis. We still do not have wide evidence of the drug's efficacy as prophylaxis, but no other alternative currently is available. Oral ganciclovir's manufacturer, Syntex, did a study of 725 PWAs at 19 medical centers in the US. The study showed the incidence of CMV retinitis halved when those on the drug were compared to those on placebo. This, of course, is not as good as Bactrim to prevent PCP, but is comparable to rifabutin's efficacy in preventing MAC. Syntex is expected to seek FDA approval sometime this year for oral ganciclovir as primary prophylaxis for CMV. The manufacturer is currently setting up a Treatment Investigational New Drug (IND) program. This program will provide oral ganciclovir at no cost to people with AIDS at high risk for developing CMV disease, until the FDA approves the drug for prophylaxis. For more information on this Treatment IND, physicians and patients can call Syntex at 1.800.569.4630.

Foscarnet is the other drug being used to treat CMV retinitis. Some believe that combining ganciclovir and foscarnet could offer treatment benefits. Two trials are currently underway and there is indication of higher levels of response to the combination than to a single drug.

Another approach to treating CMV retinitis is ganciclovir implants in the eye. The reasoning is that this gets the drug right where you want it and is thus more efficacious than the systemic use of ganciclovir. Others would argue that since CMV is a systemic disease, getting the drug throughout the body helps to prevent CMV from developing in the lungs and gut. It should be noted that ganciclovir implants have not yet been approved by the FDA. Testing continues locally; those who are interested can call Brian Terry, MD, at 818.287.2000, or the USC Doheny Eye Institute at 213.342.6466.

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©1995. AEGIS.