Induction and maintenance therapy of cytomegalovirus central nervous system infection in HIV-infected patients.
OBJECTIVE
To evaluate the efficacy and safety of the foscarnet-ganciclovir combination in induction therapy (IT) and maintenance therapy (MT) for cytomegalovirus (CMV) central neurological disorders in HIV-infected patients.


METHODS
An open pilot non-comparative multicentre study.


METHODS
Thirty-one patients with acute CMV encephalitis (CMVe) (n = 17) or CMV myelitis (CMVm) (n = 14) during the era before highly active antiretroviral therapy (HAART) received intravenous IT with foscarnet 90 mg/kg plus ganciclovir 5 mg/kg twice a day followed by MT. The primary endpoint was clinical efficacy, assessed at the end of the induction phase.


RESULTS
The foscarnet-ganciclovir combination in IT resulted in a 74% (23 out of 31 patients) clinical improvement or stabilization. Eight patients did not respond clinically. Side-effects leading to drug discontinuation occurred in 10 patients during IT. Among the 23 patients who qualified for the maintenance phase, CMV disease progressed in 10, with a median time to the first relapse of 126 days (range 64-264 days). Overall, the median survival time was 3 months [95% confidence interval (CI), 2-4 months].


CONCLUSIONS
The combination of foscarnet and ganciclovir can safely be used for CMV central nervous system (CNS) infection, with an improvement or stabilization in 74% of patients. Life-long MT with this combination is recommended as long as the immune system is profoundly impaired.
Anduze-Faris
B M
BM
Department of Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpétrière, Paris, France.
Fillet
A M
AM
Gozlan
J
J
Lancar
R
R
Boukli
N
N
Gasnault
J
J
Caumes
E
E
Livartowsky
J
J
Matheron
S
S
Leport
C
C
Salmon
D
D
Costagliola
D
D
Katlama
C
C
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D004359:Drug Therapy, Combination; D004361:Drug Tolerance; D018792:Encephalitis, Viral / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D017245:Foscarnet / Q000627:therapeutic use; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D015996:Survival Rate
D000998:Antiviral Agents; D018894:Reverse Transcriptase Inhibitors; D017245:Foscarnet; D015774:Ganciclovir