CURRENT MANAGEMENT OF CYTOMEGALOVIRUS DISEASE IN PATIENTS WITH AIDS

被引:31
作者
JACOBSON, MA [1 ]
机构
[1] UNIV CALIF SAN FRANCISCO, DEPT MED, SAN FRANCISCO, CA 94110 USA
关键词
D O I
10.1089/aid.1994.10.917
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Cytomegalovirus (CMV) infection is common in both homosexual and heterosexual HIV-infected patients, and causes disease in a substantial proportion of patients with AIDS and very low CD4(+) cell counts. Both ganciclovir, an analog of the nucleoside guanosine, and foscarnet, an analog of pyrophosphate, are licensed for treatment of CMV retinitis. They may also have a role in the treatment of gastrointestinal disease caused by CMV. In the Studies of Ocular Complications of AIDS comparative trial the two agents were equally effective against CMV retinitis, but patients receiving foscarnet had significantly longer survival, even after adjusting for covariates including antiretroviral therapy. Ongoing studies are evaluating higher dosages of foscarnet for maintenance therapy and combined therapy with ganciclovir and foscarnet. Tolerance of ganciclovir therapy has been facilitated by adjunctive therapy with colony-stimulating factors. Because both ganciclovir and foscarnet must be administered by intravenous infusion and are associated with significant toxicities, other anti-CMV agents are under active development, including HPMPC and an oral formulation of ganciclovir. Management of CMV retinitis involves individualizing therapy, balancing side effects and administration requirements, and, in many clinical settings, the overall cost of treatment.
引用
收藏
页码:917 / 923
页数:7
相关论文
共 45 条
[1]  
ANAND R, 1993, OPHTHALMOLOGY, V100, P1032
[2]   THE CLINICAL-SIGNIFICANCE OF INFECTIONS WITH CYTOMEGALOVIRUS STRAINS RESISTANT TO ANTIVIRAL DRUGS [J].
BALFOUR, HH .
RESEARCH IN VIROLOGY, 1992, 143 (03) :219-221
[3]  
BALFOUR HH, 1992, J ACQ IMMUN DEF SYND, V5, pS37
[4]  
BLANSHARD C, 1992, J ACQ IMMUN DEF SYND, V5, pS25
[5]  
CAUSEY D, 1991, J ACQ IMMUN DEF SYND, V4, pS16
[6]  
CRUMPACKER C, 1993, 1ST NAT C HUM RETR W
[7]   FOSCARNET NEPHROTOXICITY - MECHANISM, INCIDENCE AND PREVENTION [J].
DERAY, G ;
MARTINEZ, F ;
KATLAMA, C ;
LEVALTIER, B ;
BEAUFILS, H ;
DANIS, M ;
ROZENHEIM, M ;
BAUMELOU, A ;
DOHIN, E ;
GENTILINI, M ;
JACOBS, C .
AMERICAN JOURNAL OF NEPHROLOGY, 1989, 9 (04) :316-321
[8]   THE MANAGEMENT OF CYTOMEGALOVIRUS RETINITIS IN AIDS [J].
DHILLON, B .
BRITISH JOURNAL OF OPHTHALMOLOGY, 1994, 78 (01) :66-69
[9]   CONCURRENT USE OF GANCICLOVIR AND FOSCARNET TO TREAT CYTOMEGALOVIRUS-INFECTION IN AIDS PATIENTS [J].
DIETERICH, DT ;
POLES, MA ;
LEW, EA ;
MENDEZ, PE ;
MURPHY, R ;
ADDESSI, A ;
HOLBROOK, JT ;
NAUGHTON, K ;
FRIEDBERG, DN .
JOURNAL OF INFECTIOUS DISEASES, 1993, 167 (05) :1184-1188
[10]   GANCICLOVIR TREATMENT OF CYTOMEGALOVIRUS COLITIS IN AIDS - A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED MULTICENTER STUDY [J].
DIETERICH, DT ;
KOTLER, DP ;
BUSCH, DF ;
CRUMPACKER, C ;
DUMOND, C ;
DEARMAND, B ;
BUHLES, W .
JOURNAL OF INFECTIOUS DISEASES, 1993, 167 (02) :278-282