AIDS-associated infective retinitis

There are several other examples of truly unique formulations or routes of administration that we may expect to be further exploited in the future. AIDS-associated infective retinitis is treated with a drug administered by intraocular injection, and the current parlous state of retinal detachment treatments suggests that this route of administration may find wider use. It turns out that cell membranes become leaky when exposed to high voltages otherwise insoluble or excluded drugs can enter the cell under these conditions, and this uses a multi-tined stimulator, known as an electropora-tor. Needleless injectors have been available for decades, yet still seem to be under-used (the needleless injector used by Dr Bones McCoy of the USS Enterprise" is clockwork, develops several thousand pounds pressure per square inch, and feels like a mild middle-finger percussion when used over the deltoid). 

Cidofovir (Fig. 2) has been formally approved for the treatment of CMV retinitis in AIDS patients, where it is administered intravenously at a dose not exceeding 5 mg/kg once weekly during the first two weeks (and every other week thereafter). Cidofovir is also used off label for the treatment of human papilloma virus (HPV) infections (i.e., cutaneous warts, anogenital warts, laryngeal and pharyngeal papilloma), polyomavirus [i.e., progressive (i.e., multifocal leukoencephalopathy (PML)], adenovirus, herpesvirus, and poxvirus (i.e., molluscum contagiosum) infections, where it can be administered intravenously (at a dose of < 5 mg/kg once weekly or every other week) or topically as a 1% gel or cream (De Clercq and Holy 2005). Especially in immunosuppressed patients (i.e., transplant recipients), local treatment of HPV-associated lesions has often yielded spectacular results (Bonatti etal.2007). 

Cidofovir is approved for the treatment and prophylaxis of CMV retinitis in AIDS patients. It has also been used in the treatment of acyclovir-resistant (viral thymidine kinase-dehcient) HSV infections, polyomavirus-associated progressive multifocal leukoencephalopathy, condylomata acuminata (anogenital warts), and mollus-cum contagiosum. 

Fomivirsen is used to treat CMV retinitis in patients with AIDS who have not responded to other treatments or in whom other treatments are contraindicated. It appears to be at least as effective as other treatments and produces fewer side effects. Because CMV retinitis is often associated with CMV infection elsewhere in the body, patients undergoing treatment with fomivirsen should be monitored for extraocular CMV disease. 

Data regarding the clinical presentation of CMV retinitis, pattern of infection, disease course, and complications have been obtained in the last two decades because of its association with AIDS. Therapy for AIDS has been greatly improved since the mid-1990s with the development and use of highly active antiretroviral therapy (HA ART). HA ART therapy improves systemic immune function in many patients with AIDS, and thus has drastically altered the incidence and clinical features of CMV retinitis and other opportunistic infections (4). 

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