This compassionate-use study examined the efficacy of
foscarnet in patients with
AIDS and cytomegalovirus (CMV)
gastrointestinal disease who had failed
ganciclovir induction. Nineteen male homosexuals with
AIDS and biopsy-proven CMV
gastrointestinal disease who had twice failed standard
ganciclovir induction (defined as progression of clinical CMV disease) were studied.
Foscarnet 60 mg/kg every 8 h was administered intravenously for 14 days, then maintenance was utilized at 90 or 120 mg/kg every day with 1 L
normal saline daily. Endpoints included endoscopic appearance, blinded histopathologic analysis of biopsies for
CMV inclusions, and changes in symptoms by 50% from baseline. Patients were evaluated before and 2-3 wk after
foscarnet. Histopathologic improvement was seen in 67%, whereas 74% improved clinically after a median duration of 7.5 days (1-12). Among the nine with
esophageal disease, six patients (68%) had a clinical response and six of eight (75%) had a pathologic response. Among the 10 with
colonic disease, eight patients (80%) had a clinical response and six (60%) had a pathologic response. Reversible elevations in
creatinine were seen in two of 17 (12%). Three patients with
esophageal disease developed
strictures late in
therapy requiring dilation. Median survival after
foscarnet induction was 5.0 months.
Foscarnet appears to induce remission of CMV
gastrointestinal disease in 67% of patients when
ganciclovir induction has failed. Reversible nephrotoxicity occurred in 12%.
Strictures may be a late complication of CMV
esophagitis.