Document 0713
 DOCN  M94A0713
 TI    Cytomegalovirus infections in people with HIV.
 DT    9412
 AU    van der Horst C; University of North Carolina.
 SO    Annu Conf Australas Soc HIV Med. 1993 Oct 28-30;5:24 (abstract no.
       SPI-2). Unique Identifier : AIDSLINE ASHM5/94348942
 AB    By the time of death up to 40% of HIV infected people will develop life
       or sight threatening CMV infections. With some rare exceptions most of
       these infections will occur when the CD4 count drops below 100 cells/mm3
       and usually do not occur until the CD4 count is less than 50 for 12
       months. Diagnosis requires direct examination (retinitis, esophageal
       ulcers, colitis, polyradiculomyelopathy), radiologic studies
       (MRI-encephalitis), biopsy (ulcers, colitis), culture/PCR
       (polyradiculomyelopathy/encephalitis), or other lab tests (cortisol
       level-adrenalitis). The treatment varies for each diagnosis with the
       most information available for retinitis. Both foscarnet and ganciclovir
       (GCV) are equally efficacious in treating retinitis with relapse usually
       occurring in 2 months. Several studies suggest that foscarnet may
       prolong life in HIV patients by an average of 4-5 months. This could be
       due to its direct anti-HIV effect or its bonemarrow sparing effect thus
       allowing concomittant use of anti-retrovirals. The dose for induction is
       ganciclovir 5 mg/kg twice each day or foscarnet 60 mg/kg three times
       each day. The length of induction is usually 2 weeks but should be
       determined by clinical response assessed by retinal exam. Both drugs
       should be adjusted for renal disease. Side effects of GCV include bone
       marrow toxicity and thus AZT should be stopped during induction.
       Foscarnet results in electrolyte disorders with nephrotoxicity,
       hypocalcemia, hypomagnesemia, and hypophosphatemia. Therapy for
       retinitis must be lifelong with maintainance dose of GCV 5 mg/kg daily
       for 7 days or 6-7 mg/kg daily for 5 days. Foscarnet's maintainance dose
       is 90-120 mg/kg 7 days each week. At the time of the second relapse on
       GCV serious consideration should be given to switching therapy to
       foscarnet as resistance develops over time to GCV.
 DE    AIDS-Related Opportunistic Infections/DIAGNOSIS/*DRUG THERAPY
       Cytomegalovirus Infections/DIAGNOSIS/*DRUG THERAPY  Cytomegalovirus
       Retinitis/DIAGNOSIS/DRUG THERAPY  Dose-Response Relationship, Drug  Drug
       Administration Schedule  Drug Therapy, Combination  Foscarnet/ADVERSE
       EFFECTS/*THERAPEUTIC USE  Ganciclovir/ADVERSE EFFECTS/*THERAPEUTIC USE
       Human  Zidovudine/ADVERSE EFFECTS/THERAPEUTIC USE  MEETING ABSTRACT

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).