Jacobson M A
University of California at San Francisco, San Francisco General Hospital, USA.
Scand J Infect Dis Suppl. 1995;99:96-9.
An overview of the current state of antiviral therapy and prophylaxis for opportunistic cytomegalovirus (CMV) disease in 1995 is provided, focusing primarily on therapeutic trials for AIDS-related CMV retinitis. Retinitis is the most common serious CMV end-organ disease in AIDS; and it is the one for which clinical end-points can be measured most objectively and precisely. Standard antiviral chemotherapy for CMV retinitis consists of chronic intravenous treatment with either ganciclovir or foscarnet, each of which significantly delays loss of vision compared to no treatment. New agents such as HPMPC and new treatment strategies such as intravitreal ganciclovir may be more effective than standard treatment in delaying time to retinitis progression but are associated with serious toxicity problems. Preliminary data from a placebo-controlled trial of oral ganciclovir suggest that this agent reduces the risk of developing CMV end-organ disease by 50%; however, the implications of oral ganciclovir prophylaxis for development of antiviral drug resistance are unknown.
本文概述了1995年针对机会性巨细胞病毒（CMV）疾病的抗病毒治疗和预防的现状，主要聚焦于与艾滋病相关的CMV视网膜炎的治疗试验。视网膜炎是艾滋病中最常见的严重CMV终末器官疾病；也是临床终点能够最客观、精确测量的疾病。CMV视网膜炎的标准抗病毒化疗包括用更昔洛韦或膦甲酸钠进行长期静脉治疗，与不治疗相比，这两种药物都能显著延缓视力丧失。诸如HPMPC等新药以及玻璃体内注射更昔洛韦等新治疗策略，在延缓视网膜炎进展时间方面可能比标准治疗更有效，但存在严重的毒性问题。口服更昔洛韦的安慰剂对照试验的初步数据表明，该药物可将发生CMV终末器官疾病的风险降低50%；然而，口服更昔洛韦预防对抗病毒耐药性发展的影响尚不清楚。
