TreatmentUpdate 72, Vol. 8, No. 8; October 1996
Sean Hosein
Who will get CMV retinitis?
In North America, PHAs who have less than 50 CD4+ cells are at high risk for the development of CMV retinitis but not everyone with such a low cell count gets retinitis. Several research teams are developing tests to detect CMV in the blood of PHAs. Just as increasing levels of HIV in the blood (HIV viral load) is linked to wakened immunity, some doctors think that increasing levels of CMV in the blood may occur before signs of retinitis appear. Unfortunately reliable, accurate and rapid results from test kits for CMV viral load are not yet available.
CMV can infect the light-sensing part of the eye called the retina, causing it to become swollen. People with HIV/AIDS who have CMV retinitis may see:
Some people "often describe their vision loss as a curtain coming down over the eye." If left untreated, CMV retinitis results in blindness.
Standard treatment for CMV retinitis is iv (intravenous) ganciclovir or foscarnet. In some cases where CMV becomes resistant to these drugs doctors may use both of them in combination. These drugs have side effects and must be taken frequently. Recently the new anti-CMV drug cidofovir (Vistide(R), HPMPC) has been licensed in the US and is available in Canada through the EDRP (emergency drug release program). Previous reports on cidofovir have appeared in TreatmentUpdate 60.
Another approach is to place anti-CMV drugs directly into the eye. One research team has developed a slow-release form of ganciclovir, commonly called the "implant", that is inserted into the eye. They have found that the implant provides about 6 months of protection for CMV and costs about $5,000. One Canadian team has found that weekly injections of ganciclovir into the eyes of people with CMV retinitis useful. Now a group of American doctors report that injections of cidofovir need only be injected every six weeks.
1. Jabs DA. Acquired Immunodeficiency Syndrome and the eye -- 1996. Arch Ophthalmol. 1996 Jul;114(7):863-6.
2. Hodge WG, Lalond RG, Samplis J and Deschenes J. Once-weekly intra-ocular injections of ganciclovir for maintenance therapy of cytomegalovirus retinitis: clinical and ocular outcome. J Infect Dis. 1996 Aug;174(2):393-6.
3. Ward-Able C, Phillips P and Tsoukas CM. The use of oral ganciclovir in the treatment of cytomegalovirus retinitis in patients with AIDS. CMAJ. 1996 Feb 1;154(3):363-8.
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Copyright © 1996 - TreatmentUpdate. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Editor, The Canadian AIDS Treatment Information Exchange, 555 Richmond St. West, Suite 505, Box 1104, Toronto, ON, M5V 3B1 • Phone: 416-203-7122 • Toll Free: 1-800-263-1638 • Fax: 416-203-8284 http://www.catie.ca
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