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  • Title: Update on treatment of CMV retinitis.
    Author: Feinberg J.
    Journal: AIDS Clin Care; 1995 Sep; 7(9):71-3, 75, 78. PubMed ID: 11362779.
    Abstract:
    Recent developments in the treatment of CMV retinitis are highlighted, including new methods of administering ganciclovir, and use of a new parenteral agent, cidofovir (also called HPMPC). An intraocular ganciclovir sustained-release device has been developed and tested in two different trials. This implant releases 6 mg of ganciclovir over 33 to 39 weeks. In a study randomizing eyes of thirty patients with CMV retinitis, time to disease progression was 226 days for the immediate treatment group compared to 15 days in the deferred group; adverse effects are summarized. In a second study, comparing intraocular to intravenous ganciclovir in CMV retinitis patients, implant patients had a significantly longer time to retinitis progression. Significant risks to vision were noted, however, in the implant group. In another immediate vs. deferred retinitis trial, immediate intravenous cidofovir was shown to be effective, with a six-fold increase in time to progression over those who first received therapy after evidence of first progression. The primary adverse effect of intravenous cidofovir was nephrotoxicity, which was ameliorated by hydration and probenecid. Intravitreal cidofovir was studied, also resulting in delayed progression of retinitis. Finally, the use of oral ganciclovir to prevent CMV end-organ disease resulted in a decrease of CMV infections by about fifty percent, but much controversy remains due to the involvement of multiple individual factors.
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