Evaluation of Cytomegalovirus Retinitis Management

Abstract

Cytomegalovirus (CMV) is the most common pathogen of opportunistic viral infections in patients with the acquired immunodeficiency syndrome. In this study, we assessed the therapeutic outcome of our treatment regimen of CMV retinitis by analysing retrospectively 33 consecutive patients. The clinical utility of CMV cultures from blood, urine and throat specimens obtained at the time of diagnosis was additionally evaluated. Treatment started with ganciclovir (GCV) therapy. In case of relapsing retinitis, re-induction therapy was initiated, and if unsuccessful, the patient was switched to foscarnet. Patients developing resistant retinitis despite foscarnet therapy were offered a GCV-foscarnet combination therapy. Under primary GCV therapy, the median first stable interval of the whole group was 202 days (mean 238 days). Twenty-five out of 33 CMV retinitis patients (76%) responded to initial GCV therapy. Eleven of these patients showed relapsing retinitis that could be stabilised in 3 patients solely with combination therapy. Eight patients did not respond to primary GCV therapy. Three of them improved with foscarnet, but 3 patients did not respond to either treatment. In 18 (56%) out of 32 patients, CMV cultures yielded positive results. Considering our series, we may conclude that in the majority of patients primary or secondary viral resistance can be overcome by dose increase, switching to the alternative drug or a combination therapy.

Using Conjunctival Swab with Polymerase Chain Reaction to Aid Diagnosis of Cytomegalovirus Retinitis in AIDS Patients

“…In immunocompromised AIDS patients, the high morbidity of CMV infection is mainly associated with retinitis [1, 2, 3, 4, 5, 6]. Because of the fast disease progression and as the available antiviral agents are effective in the early stages of the disease, a method for accurate and confirming diagnosis is required [13].…”

“…Because of the fast disease progression and as the available antiviral agents are effective in the early stages of the disease, a method for accurate and confirming diagnosis is required [13]. The virus culture was either of lower sensitivity (34%) or time-consuming [6, 7]. The serologic procedure was often not reflecting active CMV disease in AIDS patients [9, 14].…”

“…The rate of occurence is approximately 20–40%, especially in patients whose CD4+ lymphocytes were fewer than 50 cells/µl [2, 3, 4, 5, 6]. If CMV retinitis were left untreated, it could result in progressive retina damage and loss of vision [1, 2, 3, 4, 5, 6]. Several published methods based on polymerase chain reaction (PCR), a method that can rapidly and specifically amplify signals, could quickly identify ocular CMV infection [7, 8, 9, 10, 11].…”