Table 5.

Antiviral treatment options for CMV retinitis

Drug	Dose / regimen	Comments and evidence for use
Systemic oral valganciclovir	Induction dose: 900 mg orally twice a day for 14–21 days, followed by maintenance dose of 900 mg orally once a day until CD4 count normalises	Need to monitor full blood count and renal function due to potential bone marrow suppression and renal toxicity; expensive As effective as intravenous ganciclovir for induction and long-term therapy for CMV retinitis in HIV patients20
Systemic intravenous ganciclovir	Induction dose: 5 mg/kg/dose every twelve hours for 1–21 days, followed by a maintenance dose of 5 mg/kg once a day until CD4 count normalises	Need to monitor full blood count and renal function due to potential bone marrow suppression and renal toxicity. Requires hospital attendance/admission for intravenous administration. First generation antiviral; effective22
Intravitreal ganciclovir	2.5 mg in 0.1 ml once a week	An alternative if systemic valganciclovir or ganciclovir is not available or too expensive23 All patients who have infection within 1-disc diameter of the fovea or optic disc should receive intravitreal injections Inexpensive, can be given as an outpatient Risk of endophthalmitis following intravitreal injection