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Comparative Tolerability of Therapies for Cytomegalovirus Retinitis

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Abstract

Cytomegalovirus (CMV) retinitis is a potentially sight-threatening complication of advanced HIV infection. The acute infection can be controlled with one of several therapies, including intravenous ganciclovir, foscarnet or cidofovir, slow release ganciclovir intraocular implants or serial intraocular injections of ganciclovir or foscarnet. The initial induction course of therapy is typically followed by lifelong maintenance therapy. In addition to the aforementioned treatments, oral ganciclovir and intravitreal fomivirsen injections are other options for maintenance therapy.

The choice of agent must take into consideration factors such as comparative short and long term toxicity of the agents, route of administration and the possible need for indwelling catheters, administration time, cost and protection afforded against systemic dissemination of CMV infection. Possible drug interactions and additive toxicities of other agents needed for the management of the underlying HIV infection must also be taken into consideration. These factors can affect the tolerability of therapy as well as the quality of life of the patient.

Relapse or progression of CMV retinitis may be caused by either inadequate drug concentrations at the site of the infection or by drug resistance. This may necessitate either an increase in drug dosage, a change in route of administration or a change to an alternative agent. All of these approaches can increase the risk of toxicity of the therapy.

With the initiation of highly active antiretroviral therapy and partial reconsti-tution of the immune system, some patients have been able to successfully discontinue anti-CMV maintenance therapy, thereby decreasing long term drug toxicity. Determination of the patient predictors of success of this approach is an active area of research.

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  1. Immunodeficiency Clinic, The Toronto Hospital, Toronto, Ontario, Canada

    Sharon Walmsley & Alice Tseng

  2. Department of Medicine, University of Toronto, Toronto, Ontario, Canada

    Sharon Walmsley

  3. Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada

    Alice Tseng

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Walmsley, S., Tseng, A. Comparative Tolerability of Therapies for Cytomegalovirus Retinitis. Drug-Safety 21, 203–224 (1999). https://doi.org/10.2165/00002018-199921030-00005

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