Pau A K, Pitrak D L
Department of Pharmacy Practice, College of Pharmacy, University of Illinois, Chicago 60612.
Clin Pharm. 1990 Aug;9(8):613-31.
The clinical manifestations of cytomegalovirus (CMV) infection in persons with AIDS are described, and recent advances in the management of these syndromes with antiviral agents are reviewed. CMV infection is the most common serious opportunistic viral infection in AIDS patients. Clinical manifestations include chorioretinitis, gastroenteritis, hepatitis, pneumonia, CNS infection, adrenalitis, and a wasting syndrome. The diagnosis of CMV infection requires laboratory demonstration of a serologic response to the virus, detection of viral components or products, or isolation of the virus. Ganciclovir is an acyclic nucleoside analogue marketed for the treatment of CMV-related retinitis in immunocompromised hosts. After i.v. ganciclovir induction therapy, more than 80% of patients show improvement or stabilization of retinitis. Relapse is common in AIDS patients, however, and low-dose i.v. maintenance therapy is recommended. The most serious dose-limiting effect is neutropenia. Intravitreal injection of ganciclovir has been well tolerated and efficacious. Ganciclovir has shown some efficacy in the treatment of other life-threatening CMV infections, especially gastroenteritis, but data are limited. Ganciclovir-resistant strains have been reported. Foscarnet, a pyrophosphate analogue with activity against both human CMV and human immunodeficiency virus, is undergoing clinical trials. Foscarnet has shown promise in the therapy of CMV-related retinitis, but results for other CMV infections are disappointing. Nephrotoxicity is the major dose-limiting effect. AIDS patients with sight-threatening and rapidly progressive CMV-related retinitis should be treated with ganciclovir. Foscarnet may offer an alternative when it becomes available. More must be learned about the efficacy of these drugs in the treatment of CMV infection in patients with AIDS.
本文描述了艾滋病患者巨细胞病毒（CMV）感染的临床表现，并综述了使用抗病毒药物治疗这些综合征的最新进展。CMV感染是艾滋病患者最常见的严重机会性病毒感染。临床表现包括脉络膜视网膜炎、胃肠炎、肝炎、肺炎、中枢神经系统感染、肾上腺炎和消瘦综合征。CMV感染的诊断需要通过实验室证明对该病毒的血清学反应、检测病毒成分或产物或分离病毒。更昔洛韦是一种无环核苷类似物，已上市用于治疗免疫功能低下宿主中与CMV相关的视网膜炎。静脉注射更昔洛韦诱导治疗后，超过80%的患者视网膜炎有所改善或稳定。然而，艾滋病患者中复发很常见，因此建议进行低剂量静脉维持治疗。最严重的剂量限制效应是中性粒细胞减少。玻璃体内注射更昔洛韦耐受性良好且有效。更昔洛韦在治疗其他危及生命的CMV感染，尤其是胃肠炎方面已显示出一定疗效，但数据有限。已有耐更昔洛韦毒株的报道。膦甲酸是一种焦磷酸盐类似物，对人CMV和人类免疫缺陷病毒均有活性，正在进行临床试验。膦甲酸在治疗与CMV相关的视网膜炎方面已显示出前景，但对其他CMV感染的结果令人失望。肾毒性是主要的剂量限制效应。患有威胁视力且快速进展的与CMV相关视网膜炎的艾滋病患者应使用更昔洛韦治疗。膦甲酸可用时可作为替代选择。关于这些药物在治疗艾滋病患者CMV感染方面的疗效，还需要了解更多。
