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At least 19 recordsLinked to original sources
PubMed1998

Incidence of foscarnet resistance and cidofovir resistance in patients treated for cytomegalovirus retinitis. The Cytomegalovirus Retinitis and Viral Resistance Study Group.

Cytomegalovirus (CMV) retinitis is a common opportunistic infection in patients with AIDS. With long-term therapy for CMV retinitis, resistant CMV may develop. In a prospective study of 122 patients with CMV retinitis, 2.4 and 0.8% of patients had foscarnet-resistant blood culture isolates (50% inhibitory concentration [IC50], >400 microM) and urine culture isolates, respectively, at diagnosis of CMV retinitis prior to treatment, whereas 4.1 and 6.6% had cidofovir-resistant (IC50, >2 microM) blood and urine culture isolates, respectively. Patients were treated according to best medical judgement. Of 44 foscarnet-treated patients, 26% had a resistant blood or urine culture isolate by 6 months of treatment and 37% had a resistant isolate by 9 months; of 13 cidofovir-treated patients, 29% had a resistant blood or urine culture isolate by 3 months of therapy. The probabilities of developing foscarnet resistance while on foscarnet and developing cidofovir resistance while on cidofovir were not significantly different from that for developing ganciclovir resistance while on ganciclovir (odds ratios, 1.87 [P = 0.19] and 2.28 [P = 0.15], respectively).

Adult↗
PubMed1999

Comparison of cytomegalovirus loads in plasma and leukocytes of patients with cytomegalovirus retinitis. The Cytomegalovirus Retinitis and Viral Resistance Study Group.

Cytomegalovirus (CMV) DNA loads in paired leukocyte and plasma samples from 199 patient visits by 66 patients with CMV retinitis were determined. Leukocyte CMV load determinations had a greater range of values (mean, 24,587 copies/10(6) leukocytes; maximum, 539, 000) than did plasma CMV load determinations (mean, 10,302 copies/ml; maximum, 386,000), and leukocyte viral loads were detectable in a greater proportion of patients at the time of diagnosis of CMV retinitis prior to initiation of anti-CMV therapy (82%) than were plasma viral loads (64%) (P = 0.0078). Agreement with CMV blood cultures was slightly better for plasma (kappa = 0. 68) than for leukocytes (kappa = 0.53), due to a greater proportion of patients with detectable viral loads in leukocytes having negative blood cultures.

Cytomegalovirus↗
PubMed1996

Combined ganciclovir and foscarnet in pediatric cytomegalovirus retinitis.

Cytomegalovirus retinitis is the leading cause of blindness in adults and children with acquired immunodeficiency syndrome (AIDS). Although clinical trials on therapy exist for adults, management of cytomegalovirus retinitis in children is not as well-documented. This report describes the clinical course of a 3-year-old child with cytomegalovirus retinitis. After initial failure with single-agent ganciclovir intravenous treatment, early institution of combined treatment with foscarnet and ganciclovir halted progression of the retinitis. This case report highlights the aggressive nature of cytomegalovirus retinitis in children and the consideration of early combined therapy compared to adult patients.

Child, Preschool↗
PubMedDate not supplied

Cytomegalovirus retinitis.

Cytomegalovirus retinitis is a frequent and serious complication of various conditions, including diseases characterized by impaired immunity, such as the acquired immunodeficiency syndrome. Due to recent advances in the treatment of cytomegalovirus retinitis, accurate diagnosis and management have become increasingly important. In this review, the authors present the epidemiology, clinical features, diagnostic testing, treatment with complications, and prognosis of cytomegalovirus retinitis. A differential diagnosis is presented and the characteristic ocular lesions are illustrated.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Advances in the management of AIDS-related cytomegalovirus retinitis.

Cytomegalovirus (CMV) retinitis, a common complication of the acquired immunodeficiency syndrome (AIDS), is increasing in frequency as patients infected with the human immunodeficiency virus (HIV) live longer. In recent years, the lifetime risk for CMV disease in HIV-infected persons has increased from 24.9% to 44.9%. Cytomegalovirus retinitis is usually diagnosed clinically: Almost all patients are CMV seropositive and have CD4+ counts less than 50 cells/mm3. Specific diagnostic tests that use antigen detection or quantitation of circulating nucleic acid to detect CMV are being developed, but they have not been validated for routine clinical use. Such tests would help predict disease, diagnose acute retinitis, and monitor therapy. Therapy with systemic agents, including intravenous ganciclovir, intravenous foscarnet, and intravenous cidofovir, is effective. However, it is cumbersome, costly, and associated with considerable toxicity, therapy encouraging investigation of other therapeutic approaches. Intravitreous injections with antiviral agents are effective, but the short half-life of available agents makes these injections inconvenient. Intraocular implants that slowly release ganciclovir have been effective for both acute therapy and long-term maintenance, but they need to be directly compared with intravenous and oral regimens to determine which regimen will optimally maximize convenience, preserve vision, and improve survival. Cytomegalovirus retinitis could be prevented by improved antiretroviral therapies or by immune-based therapies that would prolong the time during which patients remain immunocompetent. Once patients become immunologically susceptible to CMV end-organ disease (when their CD4+ counts decrease to < 50 cells/ mm3), specific chemotherapy with oral ganciclovir is promising, but the cost, inconvenience, toxicity, and conflicting reports of efficacy associated with this strategy mean that it needs careful assessment before it can be considered standard treatment. Management of CMV retinitis is on the verge of major changes. In the next few years, improvements in diagnostic, therapeutic, and preventive tools should reduce morbidity and mortality from this disease.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Cytomegalovirus retinitis.

Cytomegalovirus retinitis is the most common ocular opportunistic infection in patients infected with human immunodeficiency virus and remains a significant cause of visual loss in patients with the acquired immunodeficiency syndrome. Drugs are now available to treat this condition and recent advances in delivery techniques offer promising alternatives to traditional methods.

AIDS-Related Opportunistic Infections↗
PubMed2003

[Progress in the studies on cytomegalovirus retinitis].

Cytomegalovirus retinitis (CMVR) is the commonest opportunistic ocular infection in patients with human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS), typically occurs when CD4+ T cell counts fall below 50/mm3. CMVR accounts for the majority of the vision loss associated with HIV-related eye diseases. However progress in the studies on CMVR, including the prevalence, clinical features, differential diagnosis and recent advances in the management of CMVR is reviewed.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Longitudinal observations on mutations conferring ganciclovir resistance in patients with acquired immunodeficiency syndrome and cytomegalovirus retinitis: The Cytomegalovirus and Viral Resistance Study Group Report Number 8.

PURPOSE: Cytomegalovirus retinitis is the most common intraocular infection in patients with acquired immunodeficiency syndrome (AIDS). With prolonged suppressive anticytomegalovirus maintenance therapy, resistance occurs in over 25% of patients. We evaluated longitudinal changes in the cytomegalovirus genotype in patients with cytomegalovirus retinitis who developed ganciclovir resistance that was demonstrated in either the blood or urine. METHODS: Patients with AIDS and previously untreated cytomegalovirus retinitis were followed prospectively for the occurrence of resistance while on treatment. Blood and urine specimens were obtained periodically for cytomegalovirus culture according to a predetermined schedule. Positive isolates were tested for phenotypic susceptibility and for mutations in the UL97 and UL54 genes. RESULTS: A mutation conferring resistance to ganciclovir in either the UL97 or UL54 gene was detected in 18 patients. In general, patients with a genotypically resistant virus developed increasing phenotypic resistance over time. There was a suggestion that unless therapy was changed, UL97 mutations tended to persist. In seven of eight patients, the mutations identified in isolates from the blood and urine were identical. In selected patients, there was a suggestion that a mixed population of cytomegalovirus might be present. Progression of the retinitis in an involved eye (15 of 18), contralateral eye retinitis (10 of 11), and extraocular cytomegalovirus disease (5 of 18) occurred commonly among patients with resistant virus. CONCLUSION: Resistance-conferring mutations in the cytomegalovirus genome emerge and may persist when the selective pressure for resistance is maintained. Some patients appear to harbor complex subpopulations of virus with different mutations and different levels of phenotypic resistance. Changes in therapy may result in a shift in virus population and changes in the cytomegalovirus genotype identified.

AIDS-Related Opportunistic Infections↗
PubMed1992

Extended stability of ganciclovir for outpatient parenteral therapy for cytomegalovirus retinitis.

Cytomegalovirus retinitis in the human immunodeficiency virus-infected patient currently requires almost daily and lifelong parenteral ganciclovir therapy. Self-preparation of ganciclovir is not an option in the majority of patients with decreased visual acuity or poor muscle coordination. Therefore, based on current stability data, patients usually receive a 5-day supply of reconstituted drug. This requirement is unfortunately associated with poor patient compliance. If the extended stability of ganciclovir was known, then more efficient regimens for outpatient therapy could be formulated. This study was designed to determine the stability of reconstituted ganciclovir between 7 and 28 days. Ganciclovir diluted with normal saline or 5% dextrose in water to final drug concentrations of 5 or 10 mg/ml was evaluated for stability by high-pressure liquid chromatography under different conditions of storage. Samples were stored at both 4 degrees C and -20 degrees C in polyvinyl chloride bags and at 4 degrees C in ADFuse syringes. Ganciclovir remained stable under these conditions for 28 days. On the basis of these data, we have recommended that patients receive a 2-week supply of reconstituted ganciclovir for parenteral outpatient therapy. We have observed high levels of patient compliance with this regimen and no unexpected progression of retinitis over a 5-month period in three patients who received the drug in this fashion.

Cytomegalovirus Infections↗
PubMed2000

Mutations conferring ganciclovir resistance in a cohort of patients with acquired immunodeficiency syndrome and cytomegalovirus retinitis.

Cytomegalovirus (CMV) retinitis is among the most common opportunistic infections in patients with acquired immunodeficiency syndrome. In a prospective study of 210 patients with CMV retinitis, 26 were identified as having either a phenotypic or a genotypic ganciclovir-resistant isolate from either blood or urine cultures. For blood culture isolates with an IC(50) >6.0 microm for ganciclovir, the sensitivity and specificity for detecting a UL97 mutation were 95% and 98%, respectively, whereas for an IC(50) >8.0 microM they were 79% and 99%, respectively. Although there were trade-offs between the 2 thresholds for blood culture isolates, for urine culture isolates an IC(50) >8.0 microM appeared to be better at identifying genotypic resistance. UL97 mutations identified in both the blood and urine cultures of individual patients were identical in 87.5% of cases. High-level ganciclovir resistance (IC(50), >30 microM) typically, but not invariably, was associated with a mutation in both the UL97 and UL54 genes.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Natural history of untreated cytomegalovirus retinitis.

Cytomegalovirus infection is common in patients with AIDS, and often causes retinitis. Treatment is rarely curative, but the progression of retinitis is delayed. The untreated course of cytomegalovirus retinitis in AIDS is unknown. We report a 35-year-old man with retinitis who refused treatment. Retinitis resulted in blindness within 6 months. Measurement of cytomegalovirus genomes showed an increasing viral load in blood and urine.

Acquired Immunodeficiency Syndrome↗
PubMed1998

[Cytomegalovirus retinitis].

Cytomegalovirus (CMV) retinitis is the most common intraocular infection in patients with Acquired immunodeficiency syndrome (AIDS). Approximately 25% of patients with AIDS will develop CMV retinitis during their life time. It is generally associated with CD4+ lymphocyte counts of less than 50 cells/microliter. Clinically, the most characteristic feature of CMV retinitis is a yellow-white lesion of retinal necrosis with a granular border extending into the surrounding retina. At present, ganciclovir and foscarnet have been approved for the treatment of CMV retinitis in patients with AIDS. Although both drugs arrest the progression of retinitis, relapse often occurs. More than ever, ophthalmologists have a special obligation to alleviate both the physical and psychological suffering of patients with CMV retinitis.

AIDS-Related Opportunistic Infections↗
PubMed1997

Current therapeutic challenges in the treatment of cytomegalovirus retinitis.

Cytomegalovirus (CMV) retinitis has become one of the most common manifestations of active CMV infection in patients with acquired immunodeficiency syndrome (AIDS). If left untreated, it results in complete loss of vision. At present, three systemic antiviral agents-ganciclovir, foscarnet, and cidofovir-are available for treatment of CMV retinitis. Unfortunately, reactivation of retinitis will occur with all three agents, and almost all patients eventually experience disease progression while receiving treatment. Therefore, our primary therapeutic challenge is to develop a means of preventing reactivation of CMV retinitis. Another challenge is to develop drugs that can be easily administered. Thus far, oral formulations have not succeeded in effectively meeting this challenge. Direct delivery of an antiviral agent into the vitreous of an infected eye, although easily performed and more effective in delaying time to progression, is unable to prevent or delay the progression of extraocular CMV disease. The ideal antiviral agent would have high central nervous system and tissue penetration, would suppress viral replication and mutation, would be administered orally, and would be inexpensive.

AIDS-Related Opportunistic Infections↗
PubMed1999

Comparative tolerability of therapies for cytomegalovirus retinitis.

Cytomegalovirus (CMV) retinitis is a potentially sight-threatening complication of advanced HIV infection. The acute infection can be controlled with one of several therapies, including intravenous ganciclovir, foscarnet or cidofovir, slow release ganciclovir intraocular implants or serial intraocular injections of ganciclovir or foscarnet. The initial induction course of therapy is typically followed by lifelong maintenance therapy. In addition to the aforementioned treatments, oral ganciclovir and intravitreal fomivirsen injections are other options for maintenance therapy. The choice of agent must take into consideration factors such as comparative short and long term toxicity of the agents, route of administration and the possible need for indwelling catheters, administration time, cost and protection afforded against systemic dissemination of CMV infection. Possible drug interactions and additive toxicities of other agents needed for the management of the underlying HIV infection must also be taken into consideration. These factors can affect the tolerability of therapy as well as the quality of life of the patient. Relapse or progression of CMV retinitis may be caused by either inadequate drug concentrations at the site of the infection or by drug resistance. This may necessitate either an increase in drug dosage, a change in route of administration or a change to an alternative agent. All of these approaches can increase the risk of toxicity of the therapy. With the initiation of highly active antiretroviral therapy and partial reconstitution of the immune system, some patients have been able to successfully discontinue anti-CMV maintenance therapy, thereby decreasing long term drug toxicity. Determination of the patient predictors of success of this approach is an active area of research.

Antiviral Agents↗
PubMed1997

Rhegmatogenous retinal detachment in patients with cytomegalovirus retinitis: the Foscarnet-Ganciclovir Cytomegalovirus Retinitis Trial. The Studies of Ocular Complications of AIDS (SOCA) Research Group in Collaboration with the AIDS Clinical Trials Group (ACTG).

PURPOSE: To determine the incidence and risk factors for rhegmatogenous retinal detachment in a population of patients with newly diagnosed cytomegalovirus retinitis. METHODS: Analysis of selected baseline and time-dependent data on patients enrolled in a multicenter, prospective, randomized, controlled clinical trial of therapy with foscarnet vs ganciclovir. RESULTS: In 316 eyes with cytomegalovirus retinitis at baseline, the risk of rhegmatogenous retinal detachment in an eye involved by cytomegalovirus retinitis was 18.9% at 6 months (95% confidence interval [CI], 14.0% to 23.8%) and 37.9% at 1 year (95% CI, 30.5% to 45.3%). Retinal detachment was not associated with the type of anticytomegalovirus therapy (intravenous foscarnet or ganciclovir) to which the patient was assigned. Extent of retinal involvement by cytomegalovirus retinitis, higher patient age, and lower CD4+ T-cell counts were associated with an increased risk of retinal detachment; myopia was not. CONCLUSIONS: Retinal detachment in patients with cytomegalovirus retinitis is unrelated to the type of intravenous therapy used or to refractive error. The median time to retinal detachment in an involved eye with cytomegalovirus retinitis and free of retinal detachment at baseline was 18.2 months. Strategies to reduce the extent of retinitis and possibly the number of reactivations may reduce the incidence of retinal detachment.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Clinical aspects of cytomegalovirus retinitis.

Cytomegalovirus (CMV) retinitis is a sight-threatening opportunistic infection of the retina that occurs in immunosuppressed individuals. The diagnosis is based primarily on the clinical ophthalmic examination, with laboratory confirmation of systemic CMV infection. The retinitis has several characteristic appearances and a characteristic course of clinical evolution. The response to therapy with 9-[(1,3-dihydroxy-2-propoxy)methyl]guanine (DHPG, ganciclovir) has represented a significant improvement in the management of this disease. An understanding of the clinical presentation, clinical course, diagnosis, and clinical variations of CMV retinitis is important in the evaluation of the results of antiviral therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Diagnosis and treatment of cytomegalovirus retinitis.

Cytomegalovirus (CMV) retinitis is the most common ocular opportunistic infection in patients with the acquired immune deficiency syndrome (AIDS), in whom it may cause loss of vision. The early diagnosis of CMV retinitis depends on patient awareness of often subtle clinical symptoms; screening examinations may be of benefit. Aggressive treatment of the condition is imperative. Ganciclovir administered intravenously has been shown to be effective therapy, but treatment must be continued indefinitely and is associated with a risk of neutropenia. Careful monitoring during treatment is required. Investigational methods of treatment, including intravitreal injection of ganciclovir or use of foscarnet, another antiviral agent, may be of benefit if intravenous ganciclovir therapy must be discontinued.

Antiviral Agents↗
PubMedDate not supplied

Intravenous foscarnet administration for treatment of cytomegalovirus retinitis.

Cytomegalovirus (CMV) causes serious infections, particularly vision-threatening retinitis, in persons with acquired immune deficiency syndrome. Foscarnet has been demonstrated to delay the progression of CMV retinitis and is an alternative to ganciclovir. Adverse reactions to foscarnet include nephrotoxicity and hypocalcemia and can impact the patient's ability to tolerate treatment. Nursing implications and interventions essential in helping the patient achieve an optimal outcome also are presented.

AIDS-Related Opportunistic Infections↗