Ganciclovir Treatment of Gastrointestinal Infections Caused by Cytomegalovirus in Patients with AIDS

Dieterich, Douglas T.; Chachoua, Abraham; Lafleur, Francois; Worrell, Carol

doi:10.1093/clinids/10.supplement_3.s532

Cited by 67 publications

(12 citation statements)

References 4 publications

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“…Loss of mucosal protection and vascular damage due to endothelial involvement might exacerbate disease and eventually lead to perfora tions. Resolution of symptoms under antiviral treatment supports the causal role of the virus in gastrointestinal dis ease [29,140,141], In HCMV retinitis, visual loss is undoubtedly due to necrotizing infection by the virus. The retinitis has a char acteristic appearance of a continuously spreading lesion, leaving behind an area of atrophic retina [21].…”

Section: Direct Cytopathogenicitymentioning

confidence: 91%

Human Cytomegalovirus Cell Tropism and Pathogenesis

Sinzger¹,

Jahn²

1996

Intervirology

179

178

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The human cytomegalovirus (HCMV) can cause lifelong infection with episodes of endogenous reactivation. Intrauterine fetal infection and infection of immunocompromised patients are well known to result in significant morbidity. Studies on HCMV cell tropism in vivo revealed three characteristics: (1) ubiquitously distributed cell types such as epithelial cells, endothelial cells and fibroblasts are the major targets of HCMV infection; (2) leukocytes circulating in the peripheral blood are susceptible to the virus, and (3) specialized parenchymal cells such as smooth muscle cells in the gastrointestinal tract and hepatocytes can also be infected. Questions to be resolved are, how the virus spreads throughout the organism, how it can impair the function of infected organs, and how it evades the host’s immune response to establish lifelong infection. This chapter is focused on the role of HCMV-infected target cells for the pathogenesis of HCMV-associated disease in the acutely infected immunocompromised host.

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Section: Direct Cytopathogenicitymentioning

confidence: 91%

Human Cytomegalovirus Cell Tropism and Pathogenesis

Sinzger¹,

Jahn²

1996

Intervirology

179

178

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“…An additional placebo-controlled trial has confirmed and extended these findings; early ganciclovir therapy in bone marrow recipients excreting CMV but not yet ill reduced the frequency of CMV disease by 93% (from 15 of 35 to 1 of 37 patients) and significantly improved patient survival at 6 months posttransplantation (163). In uncontrolled trials of AIDS patients with CMV gastrointestinal disease, ganciclovir appeared to reduce diarrhea and the pain and dysphagia of esophagitis (62,74,109). A recent, well-controlled study of bone marrow recipients, however, indicated no benefit in this patient group (372).…”

Section: Ganciclovirmentioning

confidence: 92%

Antiviral therapy: current concepts and practices.

Bean

1992

Clinical Microbiology Reviews

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“…Viruses: CMV is one of the most common opportunistic infections in patients with AIDS, occurring late in the course of HIV infection, when immunodeficiency is severe (CD4 count less than 100 cells/µL (5,7,13,18). CMV has been identified in mucosal biopsies in as many as 45% of patients with AIDS and diarrhea (19)(20)(21)(22). A number of other viruses have been reported to involve the gastrointestinal tract in AIDS patients, including adenovirus, rotavirus, astrovirus, picobirna virus and coronavirus (23).…”

Section: Etiologymentioning

confidence: 99%

“…The most important tool for evaluating diarrhea in HIVinfected patients is the CD4 count because the absolute value reflects the patient's degree of immunodeficiency (5,9,12,13,20). In general, most opportunistic disorders are not observed until the CD4 count falls below 200 cells/µL, and more often below 100 cells/µL.…”

Section: Available Tools For Investigation Of Diarrheamentioning

confidence: 99%

Investigation of Diarrhea in AIDS

Mönkemüller

Wilcox

2000

Canadian Journal of Gastroenterology and Hepatology

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Chronic diarrhea is a common problem in patients with acquired immune deficiency syndrome (AIDS), resulting in significant morbidity and potential mortality. In the early stages of immunodeficiency, human immunodeficiency virus (HIV)-infected patients are susceptible to infection with the same enteric pathogens that cause diarrhea in immunocompetent hosts, but with progressive immunodeficiency, these patients become susceptible to numerous opportunistic disorders. The main factor to consider when tailoring the work-up of diarrhea in the HIV-infected patient is the immune status, which is reflected by the total CD4 lymphocyte cell count. A CD4 count of less than 100 cells/µL is significantly correlated with opportunistic disorders. For the HIV-infected patient with diarrhea, repeated stool studies to investigate for bacteria, ova and parasites should be the first step. When either upper or lower gastrointestinal tract symptoms are present and stool studies are negative, endoscopy directed to the probable organ of involvement is appropriate. If localizing symptoms are absent, the most appropriate next test is sigmoidoscopy with biopsies. Not infrequently, despite extensive evaluation, the cause of diarrhea in patients with AIDS remains unexplained. Recently, the widespread use of highly active antiretroviral therapy, including protease inhibitors, has led to a change in the epidemiology of diarrhea in AIDS patients. As their immune status improves, HIV-infected patients treated with combination therapy become less prone to opportunistic disorders. However, diarrhea appears to be frequent because several antiretroviral agents can themselves cause diarrhea.

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Ganciclovir Treatment of Gastrointestinal Infections Caused by Cytomegalovirus in Patients with AIDS

Cited by 67 publications

References 4 publications

Human Cytomegalovirus Cell Tropism and Pathogenesis

Human Cytomegalovirus Cell Tropism and Pathogenesis

Antiviral therapy: current concepts and practices.

Investigation of Diarrhea in AIDS

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