Document 0007
 DOCN  M9580007
 TI    Viral sensitivity testing in patients with cytomegalovirus retinitis
       clinically resistant to foscarnet or ganciclovir.
 DT    9506
 AU    Dunn JP; MacCumber MW; Forman MS; Charache P; Apuzzo L; Jabs DA; Wilmer
       Ophthalmological Institute, Baltimore, MD 21205, USA.
 SO    Am J Ophthalmol. 1995 May;119(5):587-96. Unique Identifier : AIDSLINE
       MED/95250863
 AB    PURPOSE: Resistance to antiviral therapy is a potential cause of
       progression of cytomegalovirus retinitis in patients with the acquired
       immunodeficiency syndrome. We investigated the results of viral
       sensitivity testing in a series of patients with clinically resistant
       retinitis who had positive results of blood or urine cytomegalovirus
       cultures. METHODS: All patients with newly diagnosed cytomegalovirus
       retinitis between January 1990 and December 1991 were prospectively
       studied. Blood and urine cultures for cytomegalovirus were obtained in a
       nonrandomized subgroup of this group. The results of in vitro
       sensitivity to foscarnet and ganciclovir, determined by a DNA
       hybridization assay, were then analyzed in seven patients with
       clinically resistant cytomegalovirus retinitis and whose blood or urine
       culture results, or both, were positive for cytomegalovirus while on a
       treatment regimen. RESULTS: Foscarnet-resistant cytomegalovirus (ID50 >
       300 microM) was isolated from two patients, one of whom was being
       treated with foscarnet. Ganciclovir-resistant cytomegalovirus (ID 50 >
       6.0 microM) was isolated from four patients, three of whom were being
       treated with ganciclovir. Foscarnet- and ganciclovir-resistant
       cytomegalovirus occurred with previous ganciclovir therapy in one
       patient. Clinical improvement occurred in three patients whose change in
       therapy was based on viral sensitivity testing. In general, prolonged
       therapy with one drug was associated with a progressive increase in the
       ID 50 for that drug. CONCLUSIONS: Viral resistance to foscarnet or
       ganciclovir may explain refractory cytomegalovirus retinitis in some
       patients.
 DE    Adult  AIDS-Related Opportunistic Infections/DRUG THERAPY/*VIROLOGY
       Case Report  Cytomegalovirus/DRUG EFFECTS/ISOLATION & PURIF
       Cytomegalovirus Retinitis/DRUG THERAPY/*VIROLOGY  Disease Progression
       Drug Resistance, Microbial  DNA, Viral/ANALYSIS  Female
       Foscarnet/*PHARMACOLOGY/THERAPEUTIC USE
       Ganciclovir/*PHARMACOLOGY/THERAPEUTIC USE  Human  Male  Microbial
       Sensitivity Tests  Middle Age  Prospective Studies  Support, U.S. Gov't,
       P.H.S.  Viremia/VIROLOGY  JOURNAL ARTICLE

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