Combined ganciclovir and recombinant human granulocyte-macrophage colony-stimulating factor in the treatment of cytomegalovirus retinitis in AIDS patients

Article Abstract:

Cytomegalovirus (CMV) retinitis, an inflammation of the retina caused by CMV infection, often occurs in patients with AIDS. It can lead to blindness and death if untreated. The antiviral drug ganciclovir is highly effective against this disease. However, in 40 to 50 percent of AIDS patients, ganciclovir is limited by side effects, particularly neutropenia, or abnormally low levels of a type of white blood cell. Recombinant human granulocyte-macrophage colony-stimulating factor (rHuGM-CSF) has been shown to stimulate production of these types of white blood cells. This study is examining the combined use of these two drugs; ganciclovir to treat CMV retinitis, and rHuGM-CSF to counter side effects of the former. AIDS patients with CMV retinitis are receiving either ganciclovir treatment alone or with rHuGM-CSF. The purposes of the study are to assess the safety of using the two drugs together, the ability of rHuGM-CSF to prevent neutropenia, and the development of drug interactions. The results shown are based on preliminary data from 36 of 38 patients who are enrolled in the study. The combination of both drugs has not shown any adverse effect on ganciclovir metabolism. Neutropenia has caused interruption in treatment in 12 of 21 (57 percent) of the patients receiving only ganciclovir, and in 6 of 15 (40 percent) of the patients receiving both treatments. The length of these interruptions has averaged 10.1 days in the former and 5.5 days in the latter group. Treatment of CMV retinitis has been equally effective in both groups. No statistical data has been generated so far. These preliminary results indicate that no drug-to-drug interactions exist and that combination treatment appears to reduce the incidence and severity of neutropenia. Final results should provide a clearer picture. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Neutropenia, Granulocyte-macrophage colony stimulating factor

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Overview of cytomegalovirus infections in HIV-infected patients: current therapies and future strategies

Article Abstract:

Human cytomegalovirus (CMV) is increasingly being recognized as the cause of a number of afflictions found in patients infected with human immunodeficiency virus type 1 (HIV-1), which causes AIDS. CMV retinitis, or inflammation of the retina, can lead to blindness, and has greatly increased in the past few years as an initial infection that defines the onset of AIDS. A number of antiviral drugs have become available to fight CMV infections. Ganciclovir was one of the first such drugs, and it is now used to treat CMV retinitis. Results have shown it to be effective in healing the infected retina and improving vision, but therapy must be continued indefinitely to prevent a relapse. A new drug known as foscarnet is also being tested and used to treat this infection. CMV can infect the gastrointestinal tract, causing colitis (inflammation of the colon) as well as other problems. In addition, CMV can cause pneumonia; this is complicated in AIDS patients because a number of other pneumonia-causing agents are usually involved. Ganciclovir is useful in treating both gastrointestinal and pulmonary CMV infections. Although this drug is highly effective, its precise mechanism of action is not clear. Research is focusing on this area by using drug-resistant mutants to discover how ganciclovir is activated. This knowledge can further the development of drug therapies that use a number of agents working against different manifestations of CMV infection. This research is also necessary to produce drugs that can be effective against CMV mutants that are resistant to ganciclovir. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, HIV infection, HIV infections, Viral pneumonia

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Diagnosis and treatment of cytomegalovirus retinitis

Article Abstract:

Patients with AIDS are subject to a number of opportunistic infections caused by cytomegalovirus (CMV). CMV retinitis, or inflammation of the retina, can lead to blindness, and affects 25 to 30 percent of AIDS patients. Early symptoms of this disease often go unnoticed and all patients at risk should receive regular, thorough eye examinations. The clinical appearance of the disease can vary, depending on the location of the lesion, but it usually appears as a localized, dense yellowish-white area on the retina. Cotton-wool spots, often found in AIDS patients, can be confused with CMV retinitis, but they tend to be smaller and not as well defined as the lesions observed with retinitis. The antiviral drug ganciclovir is presently used to treat this infection. It inhibits viral DNA replication, but does not destroy the virus, and thus must be given indefinitely. Initial treatment with ganciclovir is usually successful and provides a quick response, although recurrence rates of 30 to 50 percent have been reported. This drug can cause side effects, mainly the depletion of some types of white blood cells. However, treatment with ganciclovir seems to improve the overall quality of life for AIDS patients, probably by preventing other viral infections. A new drug known as foscarnet is being tested as a treatment for CMV retinitis. It does not cause the side effects associated with ganciclovir, and is now being tested in clinical trials. (Consumer Summary produced by Reliance Medical Information, Inc.)

Foscarnet

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