A 31-year-old homosexual man with
AIDS, bilateral cytomegalovirus (CMV)
retinitis and
optic neuritis in one eye, was treated with
DHPG. The
drug is an acyclic
nucleoside analogue of
guanosine with
antiviral activity. The visual acuity at the start of treatment was R.E.: no light perception and L.E.: 1.25. There was bilateral regression of
retinal exudates on
DHPG 5 mg/kg twice a day during 2 weeks. The visual result however was poor because of the optic nerve involvement, which did not improve during
DHPG treatment. Four weeks later there was a recurrence of
retinitis with the development of exudative
retinal detachment in the eye with
optic neuritis, despite maintenance
therapy of 5 mg/kg once a day Monday through Friday. The dose was increased to 5 mg/kg twice a day, but after 1 week treatment had to be discontinued because of
neutropenia. Eight days later treatment was restarted with
DHPG 5 mg/kg in a single daily dose during 17 days, which led to remission of
retinitis but
retinal reattachment did not occur. Thereafter maintenance
therapy was continued. Visual acuity remained unchanged.
DHPG appears to be effective in treating
cytomegalovirus retinitis but long-term suppressive
therapy would be necessary to prevent recurrence of the
retinitis.