Of 760
AIDS patients seen at San Francisco General Hospital in 1986, 5.7 per cent had
retinitis and 2.2 per cent had
gastrointestinal disease caused by cytomegalovirus. We reviewed the records of 44 patients treated with
ganciclovir for culture-confirmed cytomegalovirus
retinal (31 patients) or
gastrointestinal disease (17 patients) or both (four patients) in 1986.
Retinitis stabilized or improved during initial treatment with
ganciclovir in 22 of 27 (81.5 per cent) patients. Following a median 10-day induction course, 16 patients with
retinitis continued to have serial ophthalmologic assessments: eight patients were maintained on treatment and eight had maintenance treatment deferred. Before treatment, the two groups were comparable in age, Karnofsky scores, hematologic assessment, visual acuity, and history with respect to
Pneumocystis carinii pneumonia.
Retinitis did not progress for a median 53.8 days in the immediate maintenance group compared to 18.8 days for the deferred maintenance group (p = 0.01). In 17 patients with CMV
gastrointestinal disease, nine of 14 (64 per cent) had resolution of
pain and eight of 11 (73 per cent) had resolution of
diarrhea when treated initially with
ganciclovir. In both
retinitis and
gastrointestinal disease patients,
ganciclovir decreased recovery of CMV from urine and blood markedly.
Ganciclovir also caused a decrease in mean absolute neutrophil counts to about half of baseline values; decreases in mean platelet count and
hemoglobin were also noted but were less than 25 per cent.
Neutropenia severe enough to require dose adjustment (less than 800 cells/microliters) occurred in 31 per cent of patients receiving maintenance
ganciclovir.