Flores-Aguilar M, Kuppermann B D, Quiceno J I, Dankner W M, Wolf D G, Capparelli E V, Connor J D, Sherwood C H, Fullerton S, Gambertoglio J G
Department of Ophthalmology, University of California San Diego, School of Medicine.
Ophthalmology. 1993 Jul;100(7):1022-31. doi: 10.1016/s0161-6420(93)31523-x.
To determine the incidence, pathophysiology, clinical outcome, and survival in patients with clinically resistant retinitis.
Cytomegalovirus (CMV) retinitis was prospectively studied in 100 patients with acquired immune deficiency syndrome (AIDS). In 11 of these patients, clinically resistant retinitis developed, defined as new activity or progression, despite at least 8 consecutive weeks of induction doses of either foscarnet or ganciclovir. Fundus photography, pharmacokinetics, CMV cultures and sensitivities, and survival analyses were studied. The therapeutic interventions attempted after clinically resistant retinitis was identified included continuing a high dose (induction level) of the same antiviral drug, changing the antiviral drug, and combining antiviral therapy with foscarnet and ganciclovir.
Clinically resistant retinitis occurred in 11 (11%) of 100 patients with CMV retinitis and appeared to be a manifestation of acquired CMV antiviral drug resistance. Drug metabolism and pharmacokinetics in these patients were normal. The use of combination therapy with foscarnet and ganciclovir was effective in halting the progression of retinitis in three (75%) of four patients (6 of 7 eyes able to be evaluated) receiving combination therapy.
Clinically resistant retinitis is a manifestation of infection by CMV that has acquired drug resistance. In these patients, combination antiviral drug treatment should be considered. It is likely that clinically resistant retinitis will become more frequent as patients with CMV retinitis and AIDS survive longer.
确定临床耐药性视网膜炎患者的发病率、病理生理学、临床结局及生存率。
对100例获得性免疫缺陷综合征（AIDS）患者的巨细胞病毒（CMV）视网膜炎进行前瞻性研究。在这些患者中，有11例出现了临床耐药性视网膜炎，定义为尽管接受了至少连续8周的膦甲酸或更昔洛韦诱导剂量治疗，但仍有新的活动或病情进展。研究了眼底摄影、药代动力学、CMV培养及药敏试验以及生存分析。在确定临床耐药性视网膜炎后尝试的治疗干预措施包括继续使用高剂量（诱导水平）的同一种抗病毒药物、更换抗病毒药物以及将抗病毒治疗与膦甲酸和更昔洛韦联合使用。
100例CMV视网膜炎患者中有11例（11%）发生了临床耐药性视网膜炎，这似乎是获得性CMV抗病毒药物耐药性的一种表现。这些患者的药物代谢和药代动力学正常。在接受联合治疗的4例患者（7只眼中6只可评估）中的3例（75%）中，使用膦甲酸和更昔洛韦联合治疗有效地阻止了视网膜炎的进展。
临床耐药性视网膜炎是CMV感染获得耐药性后的一种表现。对于这些患者，应考虑联合抗病毒药物治疗。随着CMV视网膜炎和AIDS患者存活时间延长，临床耐药性视网膜炎可能会更频繁出现。
