Concomitant ganciclovir and zidovudine treatment for cytomegalovirus retinitis in patients with HIV infection: an approach to treatment

Article Abstract:

Patients with AIDS are subject to a number of infections caused by cytomegalovirus (CMV). CMV retinitis is an inflammation of the retina that can lead to blindness, and is one of the most common and dangerous of the CMV infections. Most AIDS patients take the drug zidovudine (AZT) to combat the human immunodeficiency virus (HIV) infection, which is the underlying cause of AIDS. AZT appears to have little effect on CMV retinitis, which left untreated, can quickly progress to blindness and death. The antiviral drug ganciclovir is the only drug presently approved to treat CMV infections. It is highly effective in treating CMV retinitis, but does not appear to have any effect on HIV. Treatment using a combination of these drugs would appear to be appropriate for patients with HIV infection. An important factor in using either drug alone or in combination is the side effects they produce. AZT can cause severe anemia. Both drugs can cause low levels of certain white blood cells (neutropenia), nausea and toxic effects in the central nervous system. In addition, HIV and CMV infections can cause anemia and neutropenia. The only data on combination treatment has come from patients with severe immunodepression (diminished immune function), which may have been responsible for the high drug toxicity reported. These studies also used high levels of AZT, which have since been proven to be unnecessary. Careful patient selection and careful monitoring and modification of the doses of AZT and ganciclovir have shown more positive results in the author's experiences. Patient selection based on neutrophil counts and testosterone levels has proven highly effective. Continuous adjustment of the AZT and ganciclovir doses or short-term discontinuation of either or both drugs, based on red and white blood cell counts, was also effective. Clinical trials using combination therapy are being conducted to clarify these issues. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Infection, HIV infection, HIV infections, Retina, Zidovudine, Ganciclovir, Cytomegaloviruses, Cytomegalovirus, editorial

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Management strategies for patients with cytomegalovirus retinitis

Article Abstract:

The treatment of cytomegalovirus retinitis in AIDS patients will require a team approach. Cytomegalovirus retinitis is an infection of the retina caused by cytomegalovirus. It is common in AIDS patients with severe immunosuppression. Its treatment requires cooperation between internists, ophthalmologists and infectious disease specialists. Ganciclovir and foscarnet are frequently used and are usually administered intravenously. However, a sustained release form of ganciclovir can be implanted in the eye. These drugs can interact with the many other drugs AIDS patients must take.

Complications and side effects, Retinal diseases, AIDS (Disease)

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