Jabs D A, Enger C, Forman M, Dunn J P
Departments of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Antimicrob Agents Chemother. 1998 Sep;42(9):2240-4. doi: 10.1128/AAC.42.9.2240.
Cytomegalovirus (CMV) retinitis is a common opportunistic infection in patients with AIDS. With long-term therapy for CMV retinitis, resistant CMV may develop. In a prospective study of 122 patients with CMV retinitis, 2.4 and 0.8% of patients had foscarnet-resistant blood culture isolates (50% inhibitory concentration [IC50], >400 microM) and urine culture isolates, respectively, at diagnosis of CMV retinitis prior to treatment, whereas 4.1 and 6.6% had cidofovir-resistant (IC50, >2 microM) blood and urine culture isolates, respectively. Patients were treated according to best medical judgement. Of 44 foscarnet-treated patients, 26% had a resistant blood or urine culture isolate by 6 months of treatment and 37% had a resistant isolate by 9 months; of 13 cidofovir-treated patients, 29% had a resistant blood or urine culture isolate by 3 months of therapy. The probabilities of developing foscarnet resistance while on foscarnet and developing cidofovir resistance while on cidofovir were not significantly different from that for developing ganciclovir resistance while on ganciclovir (odds ratios, 1.87 [P = 0.19] and 2.28 [P = 0.15], respectively).
巨细胞病毒（CMV）视网膜炎是艾滋病患者常见的机会性感染。随着对CMV视网膜炎的长期治疗，可能会出现耐药的CMV。在一项对122例CMV视网膜炎患者的前瞻性研究中，分别有2.4%和0.8%的患者在治疗前诊断为CMV视网膜炎时，血培养分离株（50%抑制浓度[IC50]，>400 microM）和尿培养分离株对膦甲酸钠耐药，而分别有4.1%和6.6%的患者血培养和尿培养分离株对西多福韦耐药（IC50，>2 microM）。患者根据最佳医学判断进行治疗。在44例接受膦甲酸钠治疗的患者中，26%在治疗6个月时有耐药的血或尿培养分离株，37%在治疗9个月时有耐药分离株；在13例接受西多福韦治疗的患者中，29%在治疗3个月时有耐药的血或尿培养分离株。接受膦甲酸钠治疗时出现膦甲酸钠耐药以及接受西多福韦治疗时出现西多福韦耐药的概率与接受更昔洛韦治疗时出现更昔洛韦耐药的概率无显著差异（优势比分别为1.87[P = 0.19]和2.28[P = 0.15]）。
