Until recently, long-term regimens consisting of daily intravenousinfusions of ganciclovir or foscarnet were the only availabletreatments for patients with cytomegalovirus (CMV) retinitis,a sight-threatening complication that affects approximatelyone third of patients in the United States with the acquiredimmunodeficiency syndrome (AIDS).1,2 In the past three years,the results of 11 randomized clinical trials of four new treatmentsfor AIDS-related CMV retinitis have been reported.3,4,5,6,7,8,9,10,11,12,13Thus, there are now new therapies from which clinicians canchoose.
Incidence and Natural History of CMV Retinitis
CMV end-organ disease has emerged as one of the most commonserious complications of AIDS, with an incidence similar tothat of . . . [Full Text of this Article]
Antiviral Drugs
Mechanism of Action and Resistance
Pharmacokinetic and Pharmacodynamic Correlations
Effect of Long-Term Antiviral Therapy on the Natural History of Retinitis
Retinal Detachment
Ophthalmologic Measurement of Drug Efficacy
Initial Treatment of CMV Retinitis
Efficacy and Toxicity
Oral Ganciclovir
Intraocular Ganciclovir Implant
Cidofovir
Salvage Treatment of CMV Retinitis
Switching from Ganciclovir to Foscarnet
Combined Therapy with Intravenous Ganciclovir and Foscarnet
Cidofovir
Intraocular Injections of Ganciclovir or Foscarnet
Intraocular Ganciclovir Implant
Anti-CMV Drugs and Regimens in Development
Conclusions
Source Information
From the Department of Medicine, University of California, San Francisco, and the Medical Service, San Francisco General Hospital, San Francisco.
Address reprint requests to Dr. Jacobson at San Francisco General Hospital, Ward 84, 995 Potrero Ave., San Francisco, CA 94110.
References
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Brand, S., Beigel, F., Olszak, T., Zitzmann, K., Eichhorst, S. T., Otte, J.-M., Diebold, J., Diepolder, H., Adler, B., Auernhammer, C. J., Goke, B., Dambacher, J.
(2005). IL-28A and IL-29 mediate antiproliferative and antiviral signals in intestinal epithelial cells and murine CMV infection increases colonic IL-28A expression. Am. J. Physiol. Gastrointest. Liver Physiol.
289: G960-G968
[Abstract][Full Text]
Williams-Aziz, S. L., Hartline, C. B., Harden, E. A., Daily, S. L., Prichard, M. N., Kushner, N. L., Beadle, J. R., Wan, W. B., Hostetler, K. Y., Kern, E. R.
(2005). Comparative Activities of Lipid Esters of Cidofovir and Cyclic Cidofovir against Replication of Herpesviruses In Vitro. Antimicrob. Agents Chemother.
49: 3724-3733
[Abstract][Full Text]
Springer, K. L., Chou, S., Li, S., Giller, R. H., Quinones, R., Shira, J. E., Weinberg, A.
(2005). How Evolution of Mutations Conferring Drug Resistance Affects Viral Dynamics and Clinical Outcomes of Cytomegalovirus-Infected Hematopoietic Cell Transplant Recipients. J. Clin. Microbiol.
43: 208-213
[Abstract][Full Text]
Springer, K. L., Weinberg, A.
(2004). Cytomegalovirus infection in the era of HAART: fewer reactivations and more immunity. J Antimicrob Chemother
54: 582-586
[Abstract][Full Text]
Griffiths, P. D.
(2002). The treatment of cytomegalovirus infection. J Antimicrob Chemother
49: 243-253
[Abstract][Full Text]
Henry, S. P., Miner, R. C., Drew, W. L., Fitchett, J., York-Defalco, C., Rapp, L. M., Levin, A. A.
(2001). Antiviral Activity and Ocular Kinetics of Antisense Oligonucleotides Designed to Inhibit CMV Replication. IOVS
42: 2646-2651
[Abstract][Full Text]
Hillman, J. D., Peng, A. T., Gilliam, A. C., Remick, S. C.
(2001). Treatment of Kaposi Sarcoma With Oral Administration of Shark Cartilage in a Human Herpesvirus 8-Seropositive, Human Immunodeficiency Virus-Seronegative Homosexual Man. Arch Dermatol
137: 1149-1152
[Full Text]
Liekens, S., Neyts, J., De Clercq, E., Verbeken, E., Ribatti, D., Presta, M.
(2001). Inhibition of Fibroblast Growth Factor-2-induced Vascular Tumor Formation by the Acyclic Nucleoside Phosphonate Cidofovir. Cancer Res.
61: 5057-5064
[Abstract][Full Text]
Nichols, W. G., Corey, L., Gooley, T., Drew, W. L., Miner, R., Huang, M.-L., Davis, C., Boeckh, M.
(2001). Rising pp65 antigenemia during preemptive anticytomegalovirus therapy after allogeneic hematopoietic stem cell transplantation: risk factors, correlation with DNA load, and outcomes. Blood
97: 867-874
[Abstract][Full Text]
Bedard, J., May, S., L'Heureux, L., Stamminger, T., Copsey, A., Drach, J., Huffman, J., Chan, L., Jin, H., Rando, R. F.
(2000). Antiviral Properties of a Series of 1,6-Naphthyridine and 7,8-Dihydroisoquinoline Derivatives Exhibiting Potent Activity against Human Cytomegalovirus. Antimicrob. Agents Chemother.
44: 929-937
[Abstract][Full Text]
CUNNINGHAM, E. T JR
(2000). Uveitis in HIV positive patients. Br. J. Ophthalmol.
84: 233-236
[Full Text]
MacCumber, M. W., Sadeghi, S., Cohen, J. A., Deutsch, T. A.
(1999). Suture Loop to Aid in Ganciclovir Implant Removal. Arch Ophthalmol
117: 1250-1254
[Abstract][Full Text]
Miller, D. M., Zhang, Y., Rahill, B. M., Waldman, W. J., Sedmak, D. D.
(1999). Human Cytomegalovirus Inhibits IFN-{alpha}-Stimulated Antiviral and Immunoregulatory Responses by Blocking Multiple Levels of IFN-{alpha} Signal Transduction. J. Immunol.
162: 6107-6113
[Abstract][Full Text]
Balfour, H. H.
(1999). Antiviral Drugs. NEJM
340: 1255-1268
[Full Text]
Erice, A.
(1999). Resistance of Human Cytomegalovirus to Antiviral Drugs. Clin. Microbiol. Rev.
12: 286-297
[Abstract][Full Text]
Bedard, J., May, S., Lis, M., Tryphonas, L., Drach, J., Huffman, J., Sidwell, R., Chan, L., Bowlin, T., Rando, R.
(1999). Comparative Study of the Anti-Human Cytomegalovirus Activities and Toxicities of a Tetrahydrofuran Phosphonate Analogue of Guanosine and Cidofovir. Antimicrob. Agents Chemother.
43: 557-567
[Abstract][Full Text]
Bush, C. E., Sluchak-Carlsen, J. A.
(1998). Evaluation of a Leukocyte Stabilization Reagent for Use in the Cytomegalovirus pp65 Antigenemia Assay. J. Clin. Microbiol.
36: 3410-3411
[Abstract][Full Text]
(1998). Antiretroviral Therapy and Medical Management of Pediatric HIV Infection. Pediatrics
102: 1005-1062
[Full Text]
Cunningham, E. T., Margolis, T. P.
(1998). Ocular Manifestations of HIV Infection. NEJM
339: 236-244
[Full Text]
Emery, V. C., Griffiths, P. D.
(2000). Prediction of cytomegalovirus load and resistance patterns after antiviral chemotherapy. Proc. Natl. Acad. Sci. USA
97: 8039-8044
[Abstract][Full Text]