title: Management of ganciclovir-resistant cytomegalovirus retinitis in HIV infection in the era of antiretroviral therapy.
abstract: The incidence of cytomegalovirus retinitis has decreased significantly since the advent of antiretroviral therapy. However, it remains an important problem in both the developed and developing worlds. Furthermore, long-term antiviral suppression is associated with a significant increase in viral resistance. We present the case of a 46-year-old man who developed cytomegalovirus retinitis one year after being diagnosed with HIV. While he initially demonstrated an excellent clinical response to ganciclovir, his cytomegalovirus viral load remained persistently elevated. Over the subsequent years, his virus developed ganciclovir resistance with a concomitant deterioration in his visual acuity. He responded poorly to salvage therapy with foscarnet and cidofovir. This case highlights the ongoing difficulty of managing cytomegalovirus disease nearly two decades into the era of antiretroviral therapy and underlines the need to develop new treatment strategies.
authors: Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland.
authors: Hugh
authors: H
authors: Adler
authors: National Virus Reference Laboratory, University College Dublin, Ireland School of Medicine and Medical Science, University College Dublin, Ireland.
authors: Cillian F
authors: CF
authors: De Gascun
authors: Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland.
authors: Fionnuala
authors: F
authors: McSweeney
authors: Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland.
authors: Robert W
authors: RW
authors: Acheson
authors: Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland.
authors: Eimear T
authors: ET
authors: Brannigan
authors: National Virus Reference Laboratory, University College Dublin, Ireland.
authors: Margaret
authors: M
authors: Duffy
authors: Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland.
authors: David J
authors: DJ
authors: Keegan
authors: Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland School of Medicine and Medical Science, University College Dublin, Ireland jlambert@mater.ie.
authors: John S
authors: JS
authors: Lambert
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000998:Antiviral Agents / Q000627:therapeutic use*; D017726:Cytomegalovirus Retinitis / Q000175:diagnosis / Q000188:drug therapy*; D017245:Foscarnet / Q000627:therapeutic use*; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016879:Salvage Therapy; D016896:Treatment Outcome; D019562:Viral Load; D014792:Visual Acuity
chemical_list: D000998:Antiviral Agents; D017245:Foscarnet
keywords: AIDS; CMV; Cytomegalovirus; HIV; ganciclovir; opportunistic infection; resistance; retinitis; treatment