title: Successful foscarnet therapy for cytomegalovirus retinitis in an AIDS patient undergoing hemodialysis: rationale for empiric dosing and plasma level monitoring.
abstract: Foscarnet is an investigational antiviral agent that has been used effectively in the treatment of cytomegalovirus (CMV) retinitis in AIDS patients. However, it has not been readily available to AIDS patients with renal insufficiency because its major side effect is nephrotoxicity. In this report, the efficacy, safety, and dosing requirements of foscarnet in a hemodialysis-dependent patient with CMV retinitis are presented. Foscarnet was administered for 14 weeks, at an initial dosage of 60 mg/kg after each dialysis session. Plasma concentrations were monitored weekly, and the dosage was adjusted to maintain peak plasma levels in the range of 500-800 microM. Although some laboratory abnormalities occurred (a preexisting anemia continued, serum calcium and phosphorus decreased, and ionized calcium increased), they did not limit therapy. Foscarnet is a potentially useful alternative treatment for CMV retinitis in hemodialysis-dependent AIDS patients.
authors.affiliation: Department of Medicine, University of Pennsylvania, Philadelphia 19104.
authors.forename: R R
authors.initials: RR
authors.lastname: MacGregor
authors.forename: A L
authors.initials: AL
authors.lastname: Graziani
authors.forename: R
authors.initials: R
authors.lastname: Weiss
authors.forename: J E
authors.initials: JE
authors.lastname: Grunwald
authors.forename: J G
authors.initials: JG
authors.lastname: Gambertoglio
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D058186:Acute Kidney Injury / Q000150:complications / Q000628:therapy; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D003586:Cytomegalovirus Infections / Q000150:complications / Q000188:drug therapy*; D015828:Eye Infections, Viral / Q000150:complications / Q000188:drug therapy; D017245:Foscarnet; D006801:Humans; D008297:Male; D010746:Phosphonoacetic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use; D006435:Renal Dialysis; D012173:Retinitis / Q000150:complications / Q000188:drug therapy*
chemical_list: D000998:Antiviral Agents; D017245:Foscarnet; D010746:Phosphonoacetic Acid