The book, "Harrison's Principles of Internal Medicine" says that, cytomegalovirus can cause: mononucleosis; pneumonia in approximately 20 percent of bone marrow transplant patients; and inflammation of the retina, or retinitis In HIV infected patients that can lead to blindness if untreated.
Ganciclovir
"Harrison's Principles of Internal Medicine" says that CMV retinitis occurs when an AIDS patient's infection fighting white blood cells called CD4+ fall below 50 to 100/microliter.
According to FDA's William Boyd, M.D., in 1989, the FDA approved ganciclovir to treat this infection; it inhibits a key enzyme in cytomegalovirus. There are three FDA approved formulations of ganciclovir: oral Cytovene capsules, intravenous Cytovene and Vitrasert implant for intraocular therapy.
Among AIDs patients with CMV retinitis, 70 to 90 percent of ganciclovir-treated patients respond, according to Cytovene's package insert.
An article published in Journal of Antimicrobial Chemotherapy, as stated by Dr. Neil A. Ettinger of Royal Marsden Hospital, showed that 5 out of 16, or 31 percent of the bone marrow transplant patients with CMV pneumonia who received treatment with ganciclovir became long-term survivors. As reported by David Emanuel, MD in The Annals of Internal Medicine, the addition of high-dose CMV immune globulin to ganciclovir improves response rates to approximately 70 percent.
Valganciclovir
Valcyt, valganciclovir, an oral drug, converts to ganciclovir in the intestine and liver. Plasma concentrations have similarities to IV ganciclovir. The FDA approved it for the treatment of CMV retinitis in AIDS patients.
Foscarnet
Foscavir, foscarnet, an intravenous drug that inhibits a key enzyme in cytomegalovirus. Importantly, foscarnet works aginst cytomegalovirus strains resistant to ganciclovir. The FDA approved it for treating CMV retinitis in AIDS patients.
Cidofovir
The FDA approved Vistide, cidofovir injection for treatment of CMV retinitis in AIDS patients who cannot tolerate ganciclovir or foscarnet, or if these drugs fail.
Fomvirsen
The FDA approved Vitravene, fomvirsen intravitreal injection. Due to a different mechanism of action, fomvirsen works against cytomegalovirus strains resistant to ganciclovir, foscarnet, or cidofovir.
References
- "Harrison's Principles of internal Medicine"; Dennis Kasper, M.D.; 2005
- "The Annals of Internal Medicine"; Cytomegalovirus Immune Globulin Prophylaxis in Liver Transplantation; David Emanuel, MD; Nov 15, 1988; Vol 109 (10), 777-782
- "Journal of Antimicrobial Chemotherapy"; Cytomegalovirus pneumonia: the use of ganciclovir in marrow transplant recipients; Neil A. Ettinger; 1989, 24, 53-62
- CYTOVENE Package Insert
- Approved Products for Treatment of CMV Retinitis in Ummunocompromised Patients; William Boyd, M.D., FDA Division of Anti-Inflammation, Analgesia and Ophthalmologic Drug Pructs
