Skip to main content
PMC home page
The British Journal of Ophthalmology logoLink to The British Journal of Ophthalmology
. 1989 Dec;73(12):996–1001. doi: 10.1136/bjo.73.12.996

Long-term outpatient treatment of CMV retinitis with ganciclovir in AIDS patients.

R W Weisenthal 1, S H Sinclair 1, I Frank 1, D H Rubin 1
PMCID: PMC1041953  PMID: 2558708

Abstract

Cytomegaloviral retinitis was diagnosed in nine eyes of seven patients with acquired immune deficiency syndrome (AIDS) on the basis of the characteristic ocular findings and a positive culture for cytomegalovirus (CMV) obtained systemically. Treatment with ganciclovir was begun on a protocol which provided two weeks of inpatient therapy at daily doses of 2.5 to 10 mg/kg followed by outpatient therapy at a reduced dosage three to six days per week. Outpatient maintenance dosage ranged from 15 mg/kg per week to 30 mg/kg per week. In seven eyes of six patients the treatment decreased retinal inflammation and stabilised the margins of the lesions. Six patients have tolerated long term maintenance therapy for 10-30 weeks. Six of seven patients (85%) in this study developed side effects from ganciclovir which required periods of a reduction in dosage or interruption of therapy. The side effects from ganciclovir included neutropenia, thrombocytopenia, drug fever, and neuropathy. Physicians using ganciclovir in AIDS patients must watch for the signs of drug toxicity and adjust treatment accordingly. Ganciclovir appears to be a promising therapy for CMV retinitis, but further work is necessary to determine the best regimen for optimal efficacy with minimal side effects.

Full text

PDF
999

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bach M. C., Bagwell S. P., Knapp N. P., Davis K. M., Hedstrom P. S. 9-(1,3-Dihydroxy-2-propoxymethyl)guanine for cytomegalovirus infections in patients with the acquired immunodeficiency syndrome. Ann Intern Med. 1985 Sep;103(3):381–382. doi: 10.7326/0003-4819-103-3-381. [DOI] [PubMed] [Google Scholar]
  2. Bachman D. M., Rodrigues M. M., Chu F. C., Straus S. E., Cogan D. G., Macher A. M. Culture-proven cytomegalovirus retinitis in a homosexual man with the acquired immunodeficiency syndrome. Ophthalmology. 1982 Jul;89(7):797–804. doi: 10.1016/s0161-6420(82)34733-8. [DOI] [PubMed] [Google Scholar]
  3. Felsenstein D., D'Amico D. J., Hirsch M. S., Neumeyer D. A., Cederberg D. M., de Miranda P., Schooley R. T. Treatment of cytomegalovirus retinitis with 9-[2-hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine. Ann Intern Med. 1985 Sep;103(3):377–380. doi: 10.7326/0003-4819-103-3-377. [DOI] [PubMed] [Google Scholar]
  4. Field A. K., Davies M. E., DeWitt C., Perry H. C., Liou R., Germershausen J., Karkas J. D., Ashton W. T., Johnston D. B., Tolman R. L. 9-([2-hydroxy-1-(hydroxymethyl)ethoxy]methyl)guanine: a selective inhibitor of herpes group virus replication. Proc Natl Acad Sci U S A. 1983 Jul;80(13):4139–4143. doi: 10.1073/pnas.80.13.4139. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Frank K. B., Chiou J. F., Cheng Y. C. Interaction of herpes simplex virus-induced DNA polymerase with 9-(1,3-dihydroxy-2-propoxymethyl)guanine triphosphate. J Biol Chem. 1984 Feb 10;259(3):1566–1569. [PubMed] [Google Scholar]
  6. Henderly D. E., Freeman W. R., Causey D. M., Rao N. A. Cytomegalovirus retinitis and response to therapy with ganciclovir. Ophthalmology. 1987 Apr;94(4):425–434. doi: 10.1016/s0161-6420(87)33454-2. [DOI] [PubMed] [Google Scholar]
  7. Holland G. N., Gottlieb M. S., Yee R. D., Schanker H. M., Pettit T. H. Ocular disorders associated with a new severe acquired cellular immunodeficiency syndrome. Am J Ophthalmol. 1982 Apr;93(4):393–402. doi: 10.1016/0002-9394(82)90127-1. [DOI] [PubMed] [Google Scholar]
  8. Holland G. N., Pepose J. S., Pettit T. H., Gottlieb M. S., Yee R. D., Foos R. Y. Acquired immune deficiency syndrome. Ocular manifestations. Ophthalmology. 1983 Aug;90(8):859–873. doi: 10.1016/s0161-6420(83)80009-8. [DOI] [PubMed] [Google Scholar]
  9. Holland G. N., Sakamoto M. J., Hardy D., Sidikaro Y., Kreiger A. E., Frenkel L. M. Treatment of cytomegalovirus retinopathy in patients with acquired immunodeficiency syndrome. Use of the experimental drug 9-[2-hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine. Arch Ophthalmol. 1986 Dec;104(12):1794–1800. doi: 10.1001/archopht.1986.01050240068042. [DOI] [PubMed] [Google Scholar]
  10. Merritt J. C., Callender C. O. Adult cytomegalic inclusion retinitis. Ann Ophthalmol. 1978 Aug;10(8):1059–1063. [PubMed] [Google Scholar]
  11. Neuwirth J., Gutman I., Hofeldt A. J., Behrens M., Marquardt M. D., Abramovsky-Kaplan I., Kelsey P., Odel J. Cytomegalovirus retinitis in a young homosexual male with acquired immunodeficiency. Ophthalmology. 1982 Jul;89(7):805–808. doi: 10.1016/s0161-6420(82)34732-6. [DOI] [PubMed] [Google Scholar]
  12. Palestine A. G., Rodrigues M. M., Macher A. M., Chan C. C., Lane H. C., Fauci A. S., Masur H., Longo D., Reichert C. M., Steis R. Ophthalmic involvement in acquired immunodeficiency syndrome. Ophthalmology. 1984 Sep;91(9):1092–1099. doi: 10.1016/s0161-6420(84)34201-4. [DOI] [PubMed] [Google Scholar]
  13. Palestine A. G., Stevens G., Jr, Lane H. C., Masur H., Fujikawa L. S., Nussenblatt R. B., Rook A. H., Manischewitz J., Baird B., Megill M. Treatment of cytomegalovirus retinitis with dihydroxy propoxymethyl guanine. Am J Ophthalmol. 1986 Jan 15;101(1):95–101. doi: 10.1016/0002-9394(86)90470-8. [DOI] [PubMed] [Google Scholar]
  14. Pepose J. S., Hilborne L. H., Cancilla P. A., Foos R. Y. Concurrent herpes simplex and cytomegalovirus retinitis and encephalitis in the acquired immune deficiency syndrome (AIDS). Ophthalmology. 1984 Dec;91(12):1669–1677. doi: 10.1016/s0161-6420(84)34108-2. [DOI] [PubMed] [Google Scholar]
  15. Rodrigues M. M., Palestine A., Nussenblatt R., Masur H., Macher A. M. Unilateral cytomegalovirus retinochoroiditis and bilateral cytoid bodies in a bisexual man with the acquired immunodeficiency syndrome. Ophthalmology. 1983 Dec;90(12):1577–1582. [PubMed] [Google Scholar]
  16. Rosecan L. R., Stahl-Bayliss C. M., Kalman C. M., Laskin O. L. Antiviral therapy for cytomegalovirus retinitis in AIDS with dihydroxy propoxymethyl guanine. Am J Ophthalmol. 1986 Apr 15;101(4):405–418. doi: 10.1016/0002-9394(86)90638-0. [DOI] [PubMed] [Google Scholar]
  17. Rosenberg P. R., Uliss A. E., Friedland G. H., Harris C. A., Small C. B., Klein R. S. Acquired immunodeficiency syndrome. Ophthalmic manifestations in ambulatory patients. Ophthalmology. 1983 Aug;90(8):874–878. [PubMed] [Google Scholar]

Articles from The British Journal of Ophthalmology are provided here courtesy of BMJ Publishing Group

RESOURCES