Foscarnet Therapy for Ganciclovir-Resistant Cytomegalovirus Retinitis in Patients with AIDS

Abstract
Infections caused by cytomegalovirus (CMV) resistantin vitroto ganciclovir, defined as requiring > 6 µmol of ganciclovir for ED50 have developed in some AIDS patients with progressive CMV retinitis despite chronic ganciclovir therapy. Two such patients (CMV isolates ED50, 9.5–14.5 µmol) were treated with foscarnet, an antiviral pyrophosphate analogueto whichboth patients' isolates demonstrated in vitro susceptibility (ED50, 40;300 µmol). Each patient had documented retinitis progression, at 2- and 1-to 5-week intervals, respectively, despitehigh-dose intravenous ganciclovir therapy. Both patients responded to foscarnet therapy with cessation of viral shedding in urine and blood. After foscarnet therapy wasstarted, retinitis stabilized in the two patients for 12 and 25 weeks, respectively, before progression recurred. Therefore, foscarnet may be effective in immuno compromised patients with rapidly progressive CMV retinitis whose CMV isolates have developed in vitro resistance to ganciclovir.

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