Cytomegalovirus infection, with AIDS

Blanshard C, Benhamou Y, Dohin E, Lernestedt JO, Gazzard BG, Katlama C. Treatment of AIDS-associated gastrointestinal cytomegalovirus infection with foscarnet and ganciclovir a randomized comparison. J Infect Dis 1995 172(3) 622-8. 

Collaborative DHPG Treatment Study Group. Treatment of serious cytomegalovirus infections with 9-(l,3-dihydroxy-2-propoxymethyl)guanine in patients with AIDS and other immunodeficiencies. N Engl J Med 1986 314(13) 801-5. 

Pneumocystis jiroveci pneumonia has been precipitated or aggravated by glucocorticoids (SEDA-20, 377 SEDA-22, 450 272,350,351). There is some concern about the use of glucocorticoids as adjunctive therapy in patients with AIDS who develop Pneumocystis jiroveci pneumonia. The immunosuppressant properties of glucocorticoids have been reported to enhance the risk of tuberculosis and other AIDS-related diseases (for example Kaposi s sarcoma or cytomegalovirus infection). 

Jacobson MA, Drew WL, Feinberg J, O Donnell JJ, Whitmore PV, Miner RD, Parenti D. Foscamet therapy for ganciclovir-resistant cytomegalovirus retinitis in patients with AIDS. J Infect Dis I99I I63(6) I348-5I. 

Huycke MM, Naguib MT, Stroemmel MM, Blick K, Monti K, Martin-Munley S, Kaufman C. A double-blind placebo-con-troUed crossover trial of intravenous magnesium sulfate for foscarnet-induced ionized hypocalcemia and hypomagnesemia in patients with AIDS and cytomegalovirus infection. Antimicrob Agents Chemother 2000 44(8) 2143-8. 

Dieterich DT, Chachoua A, Lafleur F, Worrell C. Ganciclovir treatment of gastrointestinal infections caused by cytomegalovirus in patients with AIDS. Rev Infect Dis 1988 10(Suppl 3) S532-7. 

Jacobson MA, Owen W, Campbell J, Brosgart C, Abrams DI. Tolerability of combined ganciclovir and dida-nosine for the treatment of cytomegalovirus disease associated with AIDS. Clin Infect Dis 1993 16(Suppl l) S69-73. 

On the other hand, there are reports that marijuana use is associated with compromised health status among HIV-infected individuals. Lozada et al. (1983) assessed oral manifestations of tumor and opportunistic infections in 53 AIDS-affected men with Kaposi s sarcoma (KS). Twenty-seven had biopsy-proved oral KS, the palate being the most common site. Past or present infections with cytomegalovirus, hepatitis, venereal diseases, and gastrointestinal microorganisms occurred in more than 70%. Oral candidiasis was confirmed in 57%. Heavy marijuana smoking was identified as the most common habit among these individuals. Newell et al. (1985) reported that marijuana use was a risk factor... 

Baril I, Jouan M, Agher R, et al. Impact of highly active antiretroviral therapy on onset of mycobacterium avium complex infection and cytomegalovirus disease in patients with AIDS. AIDS 2000 14 2593. 

Jacobson MA, Wilson S, Stanley H, Holtzer C, Cherrington J, Safrin S. Phase I study of combination therapy with intravenous cidofovir and oral ganciclovir for cytomegalovirus retinitis in patients with AIDS. Clin Infect Dis 1999 28 528-533. 

Chem KC, Margolis TP, Chandler DB, et al. Glycoprotein B subtyping of cytomegalovirus strains in the vitreous of patients with AIDS and cytomegalovirus retinitis. J Infect Dis 1998 178 1149-1153. 

Foscamet is an antiviral agent that inhibits replication of all known herpes viruses, including cytomegalovirus (CMV), herpes simplex virus types 1 and 2 (HSV-1, HSV-2), human herpes virus 6 (HHV-6), Epstein-Barr virus (EBV) and varicella-zoster virus (VZV). It is indicated in the treatment of CMV retinitis in patients with AIDS treatment of acyclovir-resistant mucocutaneous HSV infections in immunocompromised patients and as combination therapy with ganciclovir for patients who have relapsed after monotherapy with either drug. 

A substantial number of phosphonates have been prepared and tested against viral infections, including AIDS. Even relatively simple compounds such as the above-mentioned phosphonoformic acid (19, = 0) and phosphonoacetic acid (19, n= 1) were reported as antivirals and herpes virus inhibitors active against acyclovirresistant herpes and cytomegalovirus retinitis in patients with AIDS . The veterinary use has been mentioned ... 

Clinical uses and toxicity The drug is used for prophylaxis and treatment of cytomegalovirus (CMV) infections (including CMV retinitis) and has activity against ganciclovir-resistant strains of this virus (Table 49-1). Foscarnet inhibits herpes DNA polymerase in acyclovir-resistant strains that are thymidine kinase-deficient and may suppress such resistant herpetic infections in patients with AIDS. Adverse effects include nephrotoxicity (30% incidence) with disturbances in electrolyte balance (especially hypocalcemia), genitourinary ulceration, and CNS effects (headache, hallucinations, seizures). 

Gerberding, J.L., C.E. Bryant-LeBlanc, K. Nelson, A.R. Moss, D. Osmond, H.F. Chambers, J.R. Carlson, W.L. Drew, J.A. Levy, and M.A. Sande. 1987. Risk of transmitting the human immunodeficiency virus, cytomegalovirus, and hepatitis B virus to health care workers exposed to patients with AIDS and AIDS-related conditions./. Infect. Dis. 156 1-8. 

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