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  • Title: Responding to CMV neurologic infections.
    Author: Smart T.
    Journal: GMHC Treat Issues; 1996 Nov; 10(11):5-7, 10. PubMed ID: 11364010.
    Abstract:
    Cytomegalovirus (CMV) infections of the central nervous system (CNS) could be the most underrecognized neurologic complication of AIDS. CMV can cause a number of distinct neurologic syndromes in addition to retinitis. The actual rate of CMV CNS infection is unclear: studies show CMV encephalopathy exists in anywhere from 20 percent of the brains studied in autopsies to as high as 75 percent of cases involving more advanced cases of retinitis. Whatever the actual rate may be, unrecognized CMV encephalitis my cause both mild and severe neurocognitive impairment in patients with advanced HIV infection. CMV encephalitis symptoms are abrupt, progress rapidly, and occur late in the course of HIV disease, although signs of the most common alternate diagnosis, HIV encephalopathy, appear earlier and more gradually. There have been no prospectively controlled studies of the treatment of CMV CNS disease. Standard treatments for CMV retinitis may be inadequate as therapy for CMV infections in the brain. One explanation is that there is no treatment recovery for the extensive damage to the nerves that can be caused by the disease. ACTG 305, a 6-month, high dose, aggressive combination foscarnet/ganciclovir therapy has been developed to answer many of the nagging treatment issues surrounding CMV CNS disease as well as evaluate both quantitative CMV DNA PCR and CMV bDNA as assays for disease severity, progression, and response to therapy.
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