Document 0276
 DOCN  M9550276
 TI    Cytomegalovirus esophagitis in AIDS: a prospective evaluation of
       clinical response to ganciclovir therapy, relapse rate, and long-term
       outcome.
 DT    9505
 AU    Wilcox CM; Straub RF; Schwartz DA; Department of Medicine, Emory
       University School of Medicine,; Atlanta, Georgia 30303.
 SO    Am J Med. 1995 Feb;98(2):169-76. Unique Identifier : AIDSLINE
       MED/95150089
 AB    PURPOSE: Although cytomegalovirus (CMV) esophagitis is an important
       complication of acquired immunodeficiency syndrome, there has been
       little study specifically addressing the response to currently available
       antiviral therapy, relapse rate without maintenance therapy, and
       long-term outcome. PATIENTS AND METHODS: Over a 45-month period, 44
       patients with CMV esophagitis established endoscopically and
       histopathologically were prospectively identified from among all human
       immunodeficiency virus (HIV)-infected patients undergoing endoscopy.
       Induction therapy consisted of intravenous ganciclovir at 10 mg/kg per
       day for approximately 14 days. Foscarnet was given at 60 mg/kg every 8
       hours for nonresponders to ganciclovir. RESULTS: Of these patients, 35
       completed induction ganciclovir therapy, resulting in a complete
       response in 17 (49%) and a partial response in 10 (29%), yielding a 77%
       overall response rate. Seven of 8 nonresponders were subsequently
       treated with foscarnet, with a clinical response seen in 5 patients. In
       the 18 eventual complete responders to ganciclovir or foscarnet followed
       up without maintenance therapy, 7 (39%) relapsed at a median of 4 months
       (range 2 to 18 months). In all cases, relapse was manifested by
       recurrent odynophagia. Reinduction ganciclovir therapy yielded a
       complete response in 1 patient and a partial response in 2, and
       induction foscarnet treatment resulted in a complete response in the
       other treated patients. During long-term follow-up, 1 complete responder
       developed CMV colitis with concurrent retinitis, and 4 other patients
       developed retinitis. The median survival after diagnosis was 8.2 months,
       although survival for greater than 1 year was seen in 4 patients. No
       patient died as a direct result of esophageal disease, although
       ulcer-related bleeding may have contributed to death in 2 patients with
       end-stage liver diseases and hepatic encephalopathy. CONCLUSIONS: CMV
       esophagitis has a favorable response to induction ganciclovir therapy,
       and a long-term remission may occur after induction therapy alone.
       Despite the favorable response to ganciclovir therapy, the long-term
       survival is poor, reflecting the severe immunodeficiency of these
       patients.
 DE    Adult  AIDS-Related Opportunistic Infections/*DRUG THERAPY/VIROLOGY
       Cytomegalovirus Infections/*DRUG THERAPY/VIROLOGY  Drug Administration
       Schedule  Esophagitis/*DRUG THERAPY/VIROLOGY  Female
       Foscarnet/THERAPEUTIC USE  Ganciclovir/*THERAPEUTIC USE  Human  Male
       Probability  Prospective Studies  Recurrence  Survival Analysis
       Treatment Outcome  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
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