Jacobson M A
Department of Medicine, University of California, San Francisco 94110.
Am J Med. 1992 Feb 14;92(2A):26S-29S. doi: 10.1016/0002-9343(92)90334-8.
The use of ganciclovir in the treatment of cytomegalovirus (CMV) retinitis in patients with acquired immunodeficiency syndrome (AIDS) is limited by marrow toxicity and by the development of resistance to this agent in CMV strains capable of causing progressive disease. Foscarnet retains activity against ganciclovir-resistant CMV and has an adverse effect profile different from that of ganciclovir. Preliminary data from studies conducted under the AIDS Clinical Trials Group (ACTG) program indicate that intravenous foscarnet maintenance therapy at 60, 90, and 120 mg/kg/day in AIDS patients with CMV retinitis successfully completing foscarnet induction therapy is associated with median times to retinitis progression of 90, 95, and greater than 123 days, respectively. An ACTG trial of foscarnet in patients failing ganciclovir therapy has been initiated, as has a trial jointly sponsored by the National Eye Institute and the National Institute of Allergy and Infectious Diseases comparing the safety and efficacy of foscarnet and ganciclovir. Also underway is a trial evaluating the effects of combination and alternating regimens of these two agents.
更昔洛韦用于治疗获得性免疫缺陷综合征（AIDS）患者的巨细胞病毒（CMV）视网膜炎时，会受到骨髓毒性以及能引起疾病进展的CMV毒株对该药物产生耐药性的限制。膦甲酸钠对耐更昔洛韦的CMV仍有活性，且其不良反应与更昔洛韦不同。在艾滋病临床试验组（ACTG）项目下开展的研究的初步数据表明，对于成功完成膦甲酸钠诱导治疗的患有CMV视网膜炎的AIDS患者，分别以60、90和120mg/kg/天的剂量进行静脉膦甲酸钠维持治疗，视网膜病变进展的中位时间分别为90天、95天和超过123天。一项针对接受更昔洛韦治疗失败的患者的膦甲酸钠ACTG试验已经启动，美国国立眼科研究所和美国国立过敏与传染病研究所联合发起的一项比较膦甲酸钠和更昔洛韦的安全性和有效性的试验也已启动。此外，一项评估这两种药物联合及交替用药方案效果的试验也正在进行中。
