title: Induction and maintenance therapy of cytomegalovirus central nervous system infection in HIV-infected patients.
abstract: 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.
authors.affiliation: Department of Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpétrière, Paris, France.
authors.forename: B M
authors.initials: BM
authors.lastname: Anduze-Faris
authors.forename: A M
authors.initials: AM
authors.lastname: Fillet
authors.forename: J
authors.initials: J
authors.lastname: Gozlan
authors.forename: R
authors.initials: R
authors.lastname: Lancar
authors.forename: N
authors.initials: N
authors.lastname: Boukli
authors.forename: J
authors.initials: J
authors.lastname: Gasnault
authors.forename: E
authors.initials: E
authors.lastname: Caumes
authors.forename: J
authors.initials: J
authors.lastname: Livartowsky
authors.forename: S
authors.initials: S
authors.lastname: Matheron
authors.forename: C
authors.initials: C
authors.lastname: Leport
authors.forename: D
authors.initials: D
authors.lastname: Salmon
authors.forename: D
authors.initials: D
authors.lastname: Costagliola
authors.forename: C
authors.initials: C
authors.lastname: Katlama
mesh_terms: 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
chemical_list: D000998:Antiviral Agents; D018894:Reverse Transcriptase Inhibitors; D017245:Foscarnet; D015774:Ganciclovir