Jacobson M A, Drew W L, Feinberg J, O'Donnell J J, Whitmore P V, Miner R D, Parenti D
Department of Medicine, University of California, San Francisco.
J Infect Dis. 1991 Jun;163(6):1348-51. doi: 10.1093/infdis/163.6.1348.
Infections caused by cytomegalovirus (CMV) resistant in vitro to ganciclovir, defined as requiring greater than 6 mumols 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 mumols) were treated with foscarnet, an antiviral pyrophosphate analogue to which both patients' isolates demonstrated in vitro susceptibility (ED50, less than or equal to 300 mumols). Each patient had documented retinitis progression, at 2- and 1- to 5-week intervals, respectively, despite high-dose intravenous ganciclovir therapy. Both patients responded to foscarnet therapy with cessation of viral shedding in urine and blood. After foscarnet therapy was started, retinitis stabilized in the two patients for 12 and 25 weeks, respectively, before progression recurred. Therefore, foscarnet may be effective in immunocompromised patients with rapidly progressive CMV retinitis whose CMV isolates have developed in vitro resistance to ganciclovir.
在一些患有进行性巨细胞病毒视网膜炎的艾滋病患者中，尽管接受了长期的更昔洛韦治疗，但仍出现了对更昔洛韦体外耐药的巨细胞病毒（CMV）感染，这种耐药定义为ED50需要大于6微摩尔的更昔洛韦。两名这样的患者（CMV分离株ED50为9.5 - 14.5微摩尔）接受了膦甲酸钠治疗，这是一种抗病毒焦磷酸盐类似物，两名患者的分离株对其均表现出体外敏感性（ED50小于或等于300微摩尔）。尽管接受了高剂量静脉注射更昔洛韦治疗，但两名患者分别在2周以及1至5周的间隔期内均出现了视网膜病变进展的记录。两名患者对膦甲酸钠治疗均有反应，尿液和血液中的病毒脱落停止。在开始膦甲酸钠治疗后，两名患者的视网膜炎分别稳定了12周和25周，之后病情再次进展。因此，膦甲酸钠对于CMV分离株已出现体外对更昔洛韦耐药的免疫功能低下且患有快速进展性CMV视网膜炎的患者可能有效。
