New strategies for the management of AIDS-related CMV retinitis in the era of potent antiretroviral therapy

The management of AIDS-related cytomegalovirus (CMV) retinitis is evolving because of newly available anti-CMV drugs and because of the effect of potent antiretroviral therapy. New management issues are related to the improved immune function that occurs with antiretroviral drug use and to associated increases in patient survival. Patients can be categorized on the basis of their history of exposure to antiretroviral drugs and to their immune status; these factors will influence choices between treatment options. In some patients with improved immune function, specific anti-CMV therapy can be withdrawn altogether without reactivation of infection. There are curently many treatment options available for those who need specific anti-CMV treatment: ganciclovir via various routes (intravenous (IV), oral, intraocular implant), IV foscarnet; IV cidofovir; intravitreous fomivirsen; or a combination of these agents. Previous short-term therapies are being adapted to the long-term management of what has become a chronic disease. Management strategies also involve appropriate monitoring for the recurrence of disease activity and the development of complications, such as retinal detachment or immune recovery uveitis. This chapter provides an overview of new treatment strategies that will assist clinicians in choosing between treatment options.