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ARTICLE |

Therapy for Cytomegalovirus Retinitis: Still No Silver Lining FREE

Lucy H. Y. Young, MD, PhD
[+] Author Affiliations

This article is one of a series addressing emerging and reemerging global microbial threats.

Reprint requests to Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles St, Boston, MA 02114 (Dr Young).


JAMA. 1996;275(2):149-150. doi:10.1001/jama.1996.03530260063034
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CYTOMEGALOVIRUS (CMV) retinitis is the leading cause of visual loss in acquired immunodeficiency syndrome (AIDS), occurring in about one third of patients with AIDS. Without treatment, the disease is relentless, eventually leading to complete destruction of the retina. In the past decade, many therapeutic options have been used, but the major breakthrough in the management of this devastating disorder took place with the availability of ganciclovir and foscarnet. However, as both agents are unable to eliminate CMV from the infected retina, lifelong therapy is required. Unfortunately, despite treatment with good compliance, reactivation develops in virtually all patients over time. It is also the general impression that the relapse of the retinitis or development of new lesions takes place in increasingly shorter intervals, indicating that the disease becomes harder to control as immune status of the patient worsens.

See also p 142.

The current management of newly diagnosed CMV retitinis is

REFERENCES

Studies of Ocular Complications of AIDS Research Group in Collaboration with the AIDS Clinical Trials Group.  Mortality in patients with the acquired immunodeficiency syndrome treated with either foscarnet or ganciclovir for cytomegalovirus retinitis. N Engl J Med . 1992;;326:213-220.
Studies of Ocular Complications of AIDS Research Group, in Collaboration with the AIDS Clinical Trials Group.  Foscarnet-Ganciclovir Cytomegalovirus Retinitis Trial, 4: visual outcomes. Ophthalmology . 1994;;101:1250-1261.
Jabs DA, Enger C, Haller J, de Bustas S.  Retinal detachments in patients with cytomegalovirus retinitis. Arch Ophthalmol . 1991;;109:794-799.
Manischewitz JF, Quinnan GV, Jr, Lane HC, Wittek AE.  Synergistic effect of ganciclovir and foscarnet on cytomegalovirus replication in vitro. Antimicrob Agents Chemother . 1990;;34:373-375.
The Studies of Ocular Complications of AIDS Research Group in Collaboration With the AIDS Clinical Trials Group.  Combination foscarnet and ganciclovir therapy vs monotherapy for the treatment of relapsed cytomegalovirus retinitis in patients with AIDS: the Cytomegalovirus Retreatment Trial. Arch Ophthalmol . 1996;;114: 23-33.
Polis MA, Masur H.  Promising new treatments for cytomegalovirus retinitis. JAMA . 1995;;273:1457-1459.
Henry K, Cantrill H, Fletcher C, Chinnock BJ, Balfour HH Jr.  Use of intravitreal ganciclovir (dihydroxypropoxymethyl guanine) for cytomegalovirus retinitis in a patient with AIDS. Am J Ophthalmol . 1987;;103:17-23.
Kirsch LS, Arevalo JF, de la Paz EC, Munguia D, de Clercq E, Freeman WR.  Intravitreal cidofovir (HPMPC) treatment of cytomegalovirus retinitis in patients with acquired immune deficiency syndrome. Ophthalmology . 1995;;102:533-543.
Martin DF, Parks DJ, Mellow SD, et al.  Treatment of cytomegalovirus retinitis with an intraocular sustained-release ganciclovir implant: a randomized controlled clinical trial. Arch Ophthalmol . 1994;;112:1531-1539.
Drew WL, Ives D, Lalezari JP, et al, for the Syntex Cooperative Oral Ganciclovir Study Group.  Oral ganciclovir as maintenance treatment for cytomegalovirus retinitis in patients with AIDS. N Engl J Med . 1995;;333:615-620.

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Studies of Ocular Complications of AIDS Research Group in Collaboration with the AIDS Clinical Trials Group.  Mortality in patients with the acquired immunodeficiency syndrome treated with either foscarnet or ganciclovir for cytomegalovirus retinitis. N Engl J Med . 1992;;326:213-220.
Studies of Ocular Complications of AIDS Research Group, in Collaboration with the AIDS Clinical Trials Group.  Foscarnet-Ganciclovir Cytomegalovirus Retinitis Trial, 4: visual outcomes. Ophthalmology . 1994;;101:1250-1261.
Jabs DA, Enger C, Haller J, de Bustas S.  Retinal detachments in patients with cytomegalovirus retinitis. Arch Ophthalmol . 1991;;109:794-799.
Manischewitz JF, Quinnan GV, Jr, Lane HC, Wittek AE.  Synergistic effect of ganciclovir and foscarnet on cytomegalovirus replication in vitro. Antimicrob Agents Chemother . 1990;;34:373-375.
The Studies of Ocular Complications of AIDS Research Group in Collaboration With the AIDS Clinical Trials Group.  Combination foscarnet and ganciclovir therapy vs monotherapy for the treatment of relapsed cytomegalovirus retinitis in patients with AIDS: the Cytomegalovirus Retreatment Trial. Arch Ophthalmol . 1996;;114: 23-33.
Polis MA, Masur H.  Promising new treatments for cytomegalovirus retinitis. JAMA . 1995;;273:1457-1459.
Henry K, Cantrill H, Fletcher C, Chinnock BJ, Balfour HH Jr.  Use of intravitreal ganciclovir (dihydroxypropoxymethyl guanine) for cytomegalovirus retinitis in a patient with AIDS. Am J Ophthalmol . 1987;;103:17-23.
Kirsch LS, Arevalo JF, de la Paz EC, Munguia D, de Clercq E, Freeman WR.  Intravitreal cidofovir (HPMPC) treatment of cytomegalovirus retinitis in patients with acquired immune deficiency syndrome. Ophthalmology . 1995;;102:533-543.
Martin DF, Parks DJ, Mellow SD, et al.  Treatment of cytomegalovirus retinitis with an intraocular sustained-release ganciclovir implant: a randomized controlled clinical trial. Arch Ophthalmol . 1994;;112:1531-1539.
Drew WL, Ives D, Lalezari JP, et al, for the Syntex Cooperative Oral Ganciclovir Study Group.  Oral ganciclovir as maintenance treatment for cytomegalovirus retinitis in patients with AIDS. N Engl J Med . 1995;;333:615-620.
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