Update (1995) on clinical trials of antiviral therapy and prophylaxis for AIDS-related cytomegalovirus disease.

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.