Treatment of cytomegalovirus (CMV) disease met with limited success until the development of
ganciclovir. Favorable clinical responses to
ganciclovir have been reported in approximately 80% of immunocompromised patients with CMV
retinitis or
gastrointestinal disease. CMV
pneumonia is more difficult to treat, with
therapy benefiting 10%-72% of patients.
Ganciclovir must be given parenterally; the dose-limiting adverse event is
neutropenia. Patients with
AIDS frequently experience relapse and require maintenance
therapy.
Foscarnet is an attractive anti-CMV
drug but must be given parenterally and is completely dependent on renal clearance for elimination. Prevention of CMV disease with
antiviral drugs may be possible. Five weeks of intravenous
acyclovir (500 mg/m2 three times a day) significantly reduced the risk of CMV
infection and disease in seropositive allogeneic bone marrow transplant recipients. The prophylactic benefit of
acyclovir has recently been confirmed and extended by a placebo-controlled trial in renal allograft recipients at the University of Minnesota. A 12-week course of high doses of oral
acyclovir (3,200 mg/d) was safe and significantly reduced the incidence of CMV
infection and disease.