High-dose (5000-microg) intravitreal ganciclovir combined with highly active antiretroviral therapy for cytomegalovirus retinitis in HIV-infected patients in Venezuela.

Abstract

PURPOSE:

To describe the use of high doses of intravitreal ganciclovir combined with highly active antiretroviral therapy (HAART) for the treatment of cytomegalovirus (CMV) retinitis in human immunodeficiency virus (HIV)-infected patients.

METHODS:

Thirteen HIV-infected patients (18 eyes) with active CMV retinitis (83.3% in zone 1 and 38.4% resistant) participated in this prospective interventional case series. Patients were treated with high dose intravitreal ganciclovir (5.0 mg/0.1 mL once a week) in combination with HAART therapy. Intravitreal injections were discontinued once CMV retinitis healed if there was a significant increase in CD4+ count (any increase of > or 50 cells/microL to levels over 100 cells/microL sustained for at least 3 months). Mean follow-up was 15.6 months. Main outcome measures included assessment of visual acuity and retinal inflammation (CMV retinitis activity). A matched historical control group of 20 eyes (15 patients) with CMV retinitis treated with systemic ganciclovir (intravenous [induction] and oral [maintenance]) was included.

RESULTS:

Complete regression of the retinitis was obtained with high doses of intravitreal ganciclovir in 88.8% of eyes (two patients died during follow-up) at a mean of 4.5 weeks (2 to 8 weeks). Visual acuity improved two or more lines in 61.1% of eyes. No ganciclovir retinal toxicity was identified. Three eyes presented CMV retinitis reactivation at a mean of 25.6 days after their last injection. Complications (33.3%) included retinal detachment (RD; 3 eyes), immune recovery uveitis (IRU; 2 eyes), and endophthalmitis (1 eye). In our control group complete regression of the retinitis was obtained in 100% of eyes at a mean of 4 weeks (3 to 7 weeks). However, 12 eyes (60%) presented with CMV retinitis relapse at a mean of 29 days (21 to 32 days) after initiating oral ganciclovir (maintenance). Complications included RD (7 eyes, 35%) and IRU (3 eyes, 15%). Severe neutropenia occurred in 2 patients (13%).

CONCLUSIONS:

High doses of intravitreal ganciclovir (5.0 mg) once a week in combination with HAART therapy is effective to control CMV retinitis, and may be discontinued after CMV retinitis has healed if immune reconstitution with a significant increase in CD4+ count has occurred.

• Authors: J F Arevalo, R A Garcia, A J Mendoza
• Journal: European journal of ophthalmology (Eur J Ophthalmol) 2005 Sep-Oct Vol. 15 Issue 5 Pg. 610-8 ISSN: 1120-6721 [Print] United States
• PMID: 16167292 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-HIV Agents
• Antiviral Agents
• Ganciclovir

Topics

• AIDS-Related Opportunistic Infections (drug therapy, immunology)
• Adult
• Anti-HIV Agents (administration & dosage)
• Antiretroviral Therapy, Highly Active
• Antiviral Agents (administration & dosage, adverse effects)
• CD4 Lymphocyte Count
• CD4-Positive T-Lymphocytes (immunology)
• Cytomegalovirus Retinitis (drug therapy, immunology)
• Female
• Ganciclovir (administration & dosage, adverse effects)
• Humans
• Injections
• Male
• Middle Aged
• Prospective Studies
• Treatment Outcome
• Venezuela
• Visual Acuity
• Vitreous Body