What is used as secondary prophylaxis against cytomegalovirus (CMV) retinitis in patients with HIV infection?

Updated: Mar 09, 2021
  • Author: Justin R Hofmann, MD; Chief Editor: John Bartlett, MD  more...
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Answer

Answer

For CMV retinitis, maintenance therapy for immediate vision-threatening lesions close to the fovea consists of intravitreal injections of ganciclovir (2 mg/injection) or foscarnet (2.4 mg/injection) for 1 to 4 doses over 7 to 10 days (AIII recommendation) plus valganciclovir 900 mg PO BID for 14 to 21 days, then 900 mg PO once daily (AI recommendation). Therapy for peripheral lesions consists of systemic antiviral therapy (various regimens of ganciclovir, valganciclovir, foscarnet, and cidofovir) (AII recommendation). Maintenance therapy for central or peripheral lesions should be continued for at least 3 to 6 months and until lesions are inactive and the CD4 count has risen to more than 100 cells/μL (AII recommendation). Maintenance therapy should be stopped only after ophthalmological consultation. Quarterly retinal examinations are indicated during the follow-up period after stopping therapy (AIII recommendation). The duration of initial therapy for CMV gastrointestinal disease is 21 to 42 days or until signs and symptoms have resolved (CII recommendation). The use of maintenance therapy for CMV gastrointestinal, pulmonary, or neurological disease is not established but should probably be individualized, especially during relapses or immune reconstitution reactions.


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