Prediction, Prevention and Treatment of Cytomegalovirus Disease In Persons with AIDS

Cytomegalovirus (CMV) remains an important pathogen of persons with advanced AIDS. Studies of the pp65 antigenemia assay and amplification procedures for the detection of CMV nucleic acid indicate that the detection of CMV in blood identifies persons with AIDS at risk for developing CMV retinitis and shorter survival. Quantification of CMV load in blood further identifies those persons at highest risk for CMV disease and death. Treatment options for CMV retinitis include intravenous ganciclovir, foscarnet or cidofovir, oral ganciclovir for maintenance therapy, and intraocular administration by injection with ganciclovir, foscarnet or a new phosphorthioate oligonucleotide (fomivirsen) or by implant (ganciclovir). Anti-CMV maintenance treatment may not be required for some patients with CMV retinitis who while receiving potent antiretroviral therapy have had their CD4+ lymphocyte count rise above 100/µL. However, systematic studies are necessary to identify those patients who can have maintenance anti-CMV therapy safely discontinued and when treatment needs to be reinstituted.