Cytomegalovirus (CMV) Retinitis

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CLINICAL DESCRIPTION

Affects up to 40% of people living with HIV/AIDS with CD4 count < 50 cells/mm3. In patients already on HAART, consider drug failure or non-compliance. Uncommonly occurs in the absence of AIDS i.e., from relative immunosuppression from systemic corticosteroid use, chemotherapeutics etc. 

TREATMENT

  • Systemic treatment
    • HAART: to regain CD4 count >50/mm3 which is an effective prophylaxis against CMV retinitis
  • Anti CMV therapy
    • Ganciclovir 5mg/kg IV EVERY 12HRS for 2-3 weeks, then 5mg/kg od during the induction phase. Oral Ganciclovir 300-450mg daily for prophylaxis and maintenance may be given when retinitis is stable until CD4 count is more than 100-150 cells/µl. Ganciclovir is marrow toxic and hence the need for regular FBC checks.
    • Foscarnet 90mg/kg every 12hrs for up to 2 weeks for induction and 90- 120mg od for maintenance.
      • Foscarnet is nephrotoxic and causes electrolyte imbalances and seizures.
    • Give Valganciclovir 900mg every 12hrs in the induction phase for 3 weeks, followed by maintenance therapy of 900mg every day
    • Intravitreal treatment
      • Ganciclovir 2 mg in 0.08ml
      • Foscarnet 1.2-2.4 mg
      • Give Ganciclovir intraocular implant (for long term treatment)