  
Ganciclovir, cidofovir regimens comparable for AIDS-related CMV retinitis
Last Updated: 2001-04-30 18:18:46 EDT (Reuters Health)
WESTPORT, CT (Reuters Health) - A comparison study of ganciclovir implant plus oral ganciclovir and intravenous cidofovir shows them to be nearly equivalent in the treatment of cytomegalovirus (CMV) retinitis in patients with AIDS in the era of highly active antiretroviral therapy (HAART).
Dr. Douglas A. Jabs of the Johns Hopkins University School of Medicine in Baltimore and colleagues enrolled 61 patients between June 1997 and April 2000. They randomized 31 patients to treatment with a ganciclovir implant plus oral ganciclovir 1 gram t.i.d. The remaining 30 patients received intravenous cidofovir 5 mg/kg once a week for 2 weeks, then every other week.
There were no significant differences in mortality rates, retinitis progression, or involvement of a previously unaffected eye, the investigators write in the April issue of the American Journal of Ophthalmology.
Visual field loss was significantly greater at -7 degrees per month in the ganciclovir group than the -2 degrees per month in the cidofovir group, which the authors suggest could be due to the implant blocking a portion of the visual field. This group also experienced vitreous hemorrhage at a significantly higher rate than the cidofovir group.
Median time to withdrawal from treatment was 6.0 months in those treated with cidofovir, because of increases in serum creatinine, whereas none in the ganciclovir required discontinuation. For reasons the investigators could not explain, mental health scores improved significantly in the cidofovir group but remained unchanged in the ganciclovir group.
"While highly active antiretroviral therapy (HAART) has reduced number of new cases by 60% to 75%, CMV retinitis has not gone away," Dr. Jabs told Reuters Health.
"What we've seen here is that the rate of progression in patients on cidofovir is lower than what we saw in the era before HAART," he said. "Apparently, HAART has a modest and subclinical effect on immune function or on HIV activation of CMV, not sufficient to prevent retinitis, but enough to boost the effectiveness of cidofovir to that of the ganciclovir implant."
Am J Ophthalmol 2001;131:457-467.
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