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Treatment of cytomegalovirus retinitis in patients with the acquired immunodeficiency syndrome
ABSTRACTS EDITED BY THOMAS J. LIESEGANG, MD
• Treatment of cytomegalovirus retinitis with a sustained-release ganciclovir implant. Musch DC, Martin DF, Gordon JF*, Davis MD, Kuppermann BD, and the Ganciclovir Implant Study Group. N Engl J Med 1997;337:83-90.
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*Chiron Vision, Inc, 9342 Jeronimo Rd, Irvine, CA 92718-1903.
YTOMEGALOVIRUS (CMV) RETINITIS IS THE MOST
common opportunistic infection of the eye in patients with the acquired immunodeficiency syn drome (AIDS). Treatment is usually with systemically delivered antiviral drugs. Sustained-release, intraocu lar implants that deliver ganciclovir are an alternative method for the treatment of CMV retinitis in patients with AIDS. The authors conducted a randomized study of 188 patients with AIDS and newly diagnosed CMV retinitis. The patients were randomly assigned to treatment with an implant delivering 1 |xg of | Lg of ganciclovir per hour, an implant delivering 2 U ganciclovir per hour, or intravenous ganciclovir. The primary outcome measured was progression of CMV retinitis. The median time to progression of retinitis was 221 days with the l-|xg-per-hour implant (75 eyes), 191 days with the 2-(xg-per-hour implant (71 eyes), and 71 days with ganciclovir administered intravenously (76 eyes; P < .001). The risk of disease in the initially uninvolved eye, however, was lower with intravenous ganciclovir than with a ganciclovir implant (risk ratio, 0.5; P = .19). Patients treated with intravenous ganciclovir were also less likely to have extraocular CMV infections (0% vs 10.3% in the two implant groups; P = .04). The authors conclude that for the treatment of CMV retinitis, the sustained-release ganciclovir implant is more effective than intravenous ganciclovir, but patients treated with a ganciclovir implant alone remain at greater risk for the development of CMV infection outside of the treated eye. Concurrent treatment with oral 716
ganciclovir may prove useful in that regard and is currently under investigation. — Nancy J. Newman
• Treatment of cytomegalovirus retinitis in pa tients with the acquired immunodeficiency syn drome. Jacobson MA*. N Engl J Med 1997;337: 105-114.
A
PPROXIMATELY ONE THIRD OF PATIENTS IN THE
United States with the acquired immunodefi ciency syndrome (AIDS) are affected with cytomega lovirus (CMV) retinitis. Until recently, long-term regimens of daily intravenous infusions of ganciclovir or foscarnet were the only available treatments. In the past 3 years, the results of 11 randomized clinical trials of four new treatments for AIDS-related CMV retinitis have been reported. These treatments are oral ganciclovir, the intraocular ganciclovir implant, intravenous cidofovir, and the combination of intra venous ganciclovir and foscarnet. The author reviews the incidence and natural history of CMV retinitis, the mechanisms and effects of the available antiviral drugs, and the use of these medications in the treatment of the initial infection and recurrence. Choosing among the available treatment options involves making trade-offs among the efficacy, risk of specific toxic effects, adverse outcomes of treatment, and the aspects of treatment that affect the quality of life. The available options permit treatment choices to be individualized. — Nancy J. Newman *San Francisco General Hospital, Ward 84, 995 Potrero Ave, San Francisco, CA 94110.
AMERICAN JOURNAL OF OPHTHALMOLOGY
NOVEMBER 1997
• Treatment of cytomegalovirus retinitis with a sustained-release ganciclovir implant. Musch DC, Martin DF, Gordon JF*, Davis MD, Kuppermann BD, and the Ganciclovir Implant Study Group. N Engl J Med 1997;337:83-90.
C
*Chiron Vision, Inc, 9342 Jeronimo Rd, Irvine, CA 92718-1903.
YTOMEGALOVIRUS (CMV) RETINITIS IS THE MOST
common opportunistic infection of the eye in patients with the acquired immunodeficiency syn drome (AIDS). Treatment is usually with systemically delivered antiviral drugs. Sustained-release, intraocu lar implants that deliver ganciclovir are an alternative method for the treatment of CMV retinitis in patients with AIDS. The authors conducted a randomized study of 188 patients with AIDS and newly diagnosed CMV retinitis. The patients were randomly assigned to treatment with an implant delivering 1 |xg of | Lg of ganciclovir per hour, an implant delivering 2 U ganciclovir per hour, or intravenous ganciclovir. The primary outcome measured was progression of CMV retinitis. The median time to progression of retinitis was 221 days with the l-|xg-per-hour implant (75 eyes), 191 days with the 2-(xg-per-hour implant (71 eyes), and 71 days with ganciclovir administered intravenously (76 eyes; P < .001). The risk of disease in the initially uninvolved eye, however, was lower with intravenous ganciclovir than with a ganciclovir implant (risk ratio, 0.5; P = .19). Patients treated with intravenous ganciclovir were also less likely to have extraocular CMV infections (0% vs 10.3% in the two implant groups; P = .04). The authors conclude that for the treatment of CMV retinitis, the sustained-release ganciclovir implant is more effective than intravenous ganciclovir, but patients treated with a ganciclovir implant alone remain at greater risk for the development of CMV infection outside of the treated eye. Concurrent treatment with oral 716
ganciclovir may prove useful in that regard and is currently under investigation. — Nancy J. Newman
• Treatment of cytomegalovirus retinitis in pa tients with the acquired immunodeficiency syn drome. Jacobson MA*. N Engl J Med 1997;337: 105-114.
A
PPROXIMATELY ONE THIRD OF PATIENTS IN THE
United States with the acquired immunodefi ciency syndrome (AIDS) are affected with cytomega lovirus (CMV) retinitis. Until recently, long-term regimens of daily intravenous infusions of ganciclovir or foscarnet were the only available treatments. In the past 3 years, the results of 11 randomized clinical trials of four new treatments for AIDS-related CMV retinitis have been reported. These treatments are oral ganciclovir, the intraocular ganciclovir implant, intravenous cidofovir, and the combination of intra venous ganciclovir and foscarnet. The author reviews the incidence and natural history of CMV retinitis, the mechanisms and effects of the available antiviral drugs, and the use of these medications in the treatment of the initial infection and recurrence. Choosing among the available treatment options involves making trade-offs among the efficacy, risk of specific toxic effects, adverse outcomes of treatment, and the aspects of treatment that affect the quality of life. The available options permit treatment choices to be individualized. — Nancy J. Newman *San Francisco General Hospital, Ward 84, 995 Potrero Ave, San Francisco, CA 94110.
AMERICAN JOURNAL OF OPHTHALMOLOGY
NOVEMBER 1997