PMID: 8970676Nov 1, 1996Paper

Consequences for the management of cytomegalovirus

AIDS
C Katlama

Abstract

Recent advances in the field of antiretroviral therapy have led to a new era where it is possible to effectively prolong the survival of HIV-infected patients. However, a corollary is the increasing prevalence of opportunistic infections, such as cytomegalovirus (CMV). CMV disease is associated with substantial morbidity, mortality, moral prejudice, impaired quality of life and cost. The natural history of CMV infection consists of three phases: there is latent CMV infection with a low CMV viral load where, ideally, prophylactic treatment is indicated; then at the opposite end of the spectrum there is CMV visceral localization, associated with clinical symptoms and tissue injuries, where acute therapy is required. In between these two stages, there is reactivation of CMV, in the absence of clinical symptoms, characterized by a medium or high viral load. Early pre-emptive therapy is indicated at this stage. It is clearly very important to distinguish between these stages in order that the patient receives optimum therapy. PROPHYLAXIS AND PRE-EMPTIVE THERAPY: A recent large, placebo-controlled study has revealed the prophylactic efficacy of oral ganciclovir, with a significant reduction in the incidence of CMV disease after both ...Continue Reading

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