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Treatment of HIV-related cytomegalovirus disease of the gastrointestinal tract with foscarnet.

Abstract
Gastrointestinal cytomegalovirus (CMV) disease occurs in a significant proportion of patients with AIDS. A series of 66 AIDS patients with first-episode gastrointestinal CMV disease diagnosed on the basis of clinical and histopathologic findings were treated with foscarnet as first-line therapy at our institution between January 1987 and January 1991. Primary sites of infection were the colon (28 patients) and the esophagus (22 patients). Foscarnet was administered as a continuous infusion of 200 mg/kg (prior to 1988) or as an intermittent infusion of 60 mg/kg t.i.d. or 90 mg/kg b.i.d., with saline hyperhydration accompanying each infusion. Patients were treated initially for 2 weeks, with an additional 1-2 weeks of treatment being given in those not having a complete response during initial treatment; maintenance therapy was given only in cases of concurrent CMV retinitis. Complete response to foscarnet therapy (resolution of symptoms and endoscopic findings) was observed in 17 esophagitis patients (77%) within 3 weeks, with only 4 patients relapsing (at 1-7 months) and none developing colitis or retinitis. Complete response was observed in 16 colitis patients (57%) within 3 weeks, with relapse occurring in 5. Asymptomatic hypocalcemia occurred in 19.7% of patients and penile ulceration occurred in 6.1%; increases in serum creatinine were observed in five patients (7.6%), but did not require discontinuation of treatment. These findings indicate that foscarnet is an effective first-line treatment for gastrointestinal CMV infection. They also suggest that maintenance therapy with foscarnet may not be required in all patients.
AuthorsC Blanshard
JournalJournal of acquired immune deficiency syndromes (J Acquir Immune Defic Syndr) Vol. 5 Suppl 1 Pg. S25-8 ( 1992) ISSN: 0894-9255 [Print] UNITED STATES
PMID1318364 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)
Chemical References
  • Antiviral Agents
  • Foscarnet
  • Phosphonoacetic Acid
Topics
  • Acquired Immunodeficiency Syndrome (complications, drug therapy)
  • Antiviral Agents (adverse effects, therapeutic use)
  • Cytomegalovirus Infections (complications, drug therapy)
  • Female
  • Foscarnet
  • Gastrointestinal Diseases (complications, drug therapy)
  • Humans
  • Male
  • Phosphonoacetic Acid (adverse effects, analogs & derivatives, therapeutic use)

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