Concurrent Use of Ganciclovir and Foscarnet to Treat Cytomegalovirus Infection in AIDS Patients

Abstract

Ten patients with AIDS and progressive cytomegalovirus disease were treated with ganciclovir and foscarnet concurrently. The patients had received ganciclovir and foscarnet monotherapy a median of 330 days before receiving combination therapy for a median of 80 days. Nine of the 10 patients responded to the combination. No electrolyte abnormalities were noted during combination therapy, but rates of neutropenia (relative rate, combination vs. ganciclovir, 1.99; P = .229) and thrombocytopenia (relative rate, combination vs. ganciclovir, 1.53; P = .616) were higher with combination therapy than with either drug alone. The relative rate of anemia was significantly increased with combination therapy compared with monotherapy (relative rate, combination vs. ganciclovir, 2.69; P = .025). These data suggest that combination ganciclovir and foscarnet therapy after failure of either alone appears to be as effective as standard therapy with single agents. The rate of anemia with combination therapy was significantly greater than either agent alone, but no significant difference was noted among the other parameters of toxicity studied.

Cerebral mass lesion due to cytomegalovirus in a patient with AIDS: case report and literature review

“…A small study of patients that received solid organ transplantation 25 concluded that combined antiviral therapy with ganciclovir and foscarnet are safe and could possibly benefit those patients harboring ganciclovir-resistant strains. Moreover, combined use of ganciclovir and foscarnet could be more aggressive therapeutic approach due to their presumed synergy 9 . Considering these aspects, some authors suggest the use of combined therapies for central nervous system CMV involvement 8,20 .…”

Relevance of clinical and laboratory findings in the diagnosis of cytomegalovirus encephalitis in patients with AIDS

“…A possible therapeutic approach in these patients could be to combine ganciclovir and foscarnet. These agents show synergy in vitro (41) and, used together, gave good results in both CMV-related neurological and extraneurological infection (29,(42)(43)(44).…”

Is combination antiviral therapy for CMV superior to monotherapy?

“…Single case reports have described clinical efficacy of the combination of ganciclovir plus foscarnet for treating CMV viremia and/or disease in patients who were suspected to have GCV susceptible virus (Dieterich et al, 1993). Bacigalupo et al (1996) used preemptive GCV plus foscarnet to treat 32 allogenic hemopoietic stem cell transplant (HSCT) recipients who developed CMV antigenemia (>4 cells/200,000).…”