Info

Duration: always at least three weeks

Treatment of choice

Valganciclovir

Valganciclovir (Valcyte™) 2 tbl. a 450 mg bid

Alternative

Ganciclovir

Ganciclovir 5 mg/kg i.v. bid

Alternative

Foscarnet

Foscarnet 90 mg/kg i.v. bid

Alternative

Ganciclovir + Foscarnet

Half of the doses above

Maintenance therapy

Discontinue when > 100-150 CD4 cells/|jl > 6 mo

Treatment of choice

Valganciclovir

Valganciclovir (Valcyte™) 1 tbl. a 450 mg bid

Alternative

Foscarnet

Foscarnet 120 mg/kg i.v. qd on 5 days/week

Alternative

Cidofovir

Cidofovir (Vistide™) 5 mg/kg i.v. qd every 14 days (plus probenecid hydration according to protocol, see Drugs section)

Primary prophylaxis

Not recommended

Discontinuation of secondary prophylaxis as quickly as possible, is therefore also desirable and practical for this OI (MacDonald 1998, Tural 1998, Jouan 2001). According to US guidelines, it should occur at the earliest after six months of maintenance therapy and with an immune reconstitution above 100-150 CD4 cells/^l. However, we have even successfully stopped ganciclovir at lower CD4-cell counts, if both HIV and CMV PCR in blood were below the level of detection. One study showed that stopping after 18 months of HAART/maintenance therapy can be safe above 75 CD4 cells/^l (Jouan 2001). Following discontinuation, patients should receive ophthalmological checks at least once a month initially.

The previously required life-long daily infusions of ganciclovir or foscarnet via port, pumps and nursing service are luckily now a thing of the past. If there are relapses under oral valganciclovir, we recommend re-induction and maintenance therapy with foscarnet or possibly with cidofovir.

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