Management of cytomegalovirus disease with antiviral drugs.
Treatment of cytomegalovirus (CMV) disease met with limited success until the development of ganciclovir. Favorable clinical responses to ganciclovir have been reported in approximately 80% of immunocompromised patients with CMV retinitis or gastrointestinal disease. CMV pneumonia is more difficult to treat, with therapy benefiting 10%-72% of patients. Ganciclovir must be given parenterally; the dose-limiting adverse event is neutropenia. Patients with AIDS frequently experience relapse and require maintenance therapy. Foscarnet is an attractive anti-CMV drug but must be given parenterally and is completely dependent on renal clearance for elimination. Prevention of CMV disease with antiviral drugs may be possible. Five weeks of intravenous acyclovir (500 mg/m2 three times a day) significantly reduced the risk of CMV infection and disease in seropositive allogeneic bone marrow transplant recipients. The prophylactic benefit of acyclovir has recently been confirmed and extended by a placebo-controlled trial in renal allograft recipients at the University of Minnesota. A 12-week course of high doses of oral acyclovir (3,200 mg/d) was safe and significantly reduced the incidence of CMV infection and disease.
Balfour
H H
HH
Department of Laboratory Medicine University of Minnesota Health Sciences Center, Minneapolis 55455.
D000212:Acyclovir / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000517:prevention & control; D017245:Foscarnet; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D010746:Phosphonoacetic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011741:Pyrimidine Nucleosides / Q000627:therapeutic use; D014740:Vidarabine / Q000627:therapeutic use
D000998:Antiviral Agents; D011741:Pyrimidine Nucleosides; D017245:Foscarnet; D014740:Vidarabine; D010746:Phosphonoacetic Acid; D015774:Ganciclovir; D000212:Acyclovir