Future directions in the management of cytomegalovirus infections.

Ganciclovir currently is the only agent approved for use in the treatment of cytomegalovirus (CMV) retinitis in immunocompromised patients, including those with the acquired immune deficiency syndrome (AIDS). Its effect against CMV in vitro and in vivo suggests its usefulness in other types of CMV infection as well. Investigations of the use of this agent in the treatment of AIDS patients with CMV gastrointestinal disease and in the treatment or prevention of CMV disease in transplant recipients are ongoing. In other studies, issues important to the management of patients receiving ganciclovir therapy are being addressed. Particular objectives include characterizing the scope of ganciclovir resistance in CMV, detailing the prospects for the tolerance of coadministered ganciclovir and zidovudine, and determining the plausibility of enhancing drug delivery through the concomitant use of recombinant human granulocyte-macrophage colony-stimulating factor and through oral administration of the agent.