switched to foscarnet. If there is only a partial response to ganciclovir, the patient can be rein-duced with ganciclovir for several more weeks. It may also become necessary to switch between medications when serious toxicity begins.
Maintenance therapy appears to be necessary for the long-term control of symptoms as well as prevention of CMV dissemination to other sites. Maintenance therapy is controversial for CMV gastrointestinal disease, though, in contrast to CMV retinitis. Progression during maintenance therapy requires reinduction. If both medications fail to result in improvement of gastrointestinal CMV disease, then combined treatment is often recommended.
Treatment of CMV disease with oral agents is being considered. This will permit home therapy and decrease the dangers of infection due to permanent indwelling catheters. The benefit of oral therapy on quality of life could be enormous. Both agents appear to have problems with absorption via the oral route. Newer agents, such as a precursor of the anti-herpes drug acyclovir, called valacyclovir, are also being studied for treatment and prophylaxis. Valacyclovir is better absorbed than ganciclovir and is completely metabolized to acyclovir, resulting in serum concentrations similar to that achieved by intravenous administration of acyclovir. Another drug called HPMPC is also being studied but appears to be too toxic for routine use. It is associated with severe damage to the kidney, although concurrent use of probenicid may help prevent this.
cytomegalovirus (CMV) disease Disease caused by infection with cytomegalovirus. See colitis; esophagitis; gastritis; neurological disease-pneumonia; polyradiculopathy; retinitis.
cytomegalovirus encephalitis encephalitis caused by cytomegalovirus. Studies have shown that CMV encephalopathy is underdiagnosed. It frequently occurs unnoticed in persons with CMV retinitis. Symptoms include dementia, headache, confusion, and fever. The infection progresses rapidly, leading to death within weeks or months.
Was this article helpful?