From the Guidelines
The recommended treatment for CMV retinitis typically involves a two-phase approach: induction therapy followed by maintenance therapy, with options including intravenous ganciclovir, valganciclovir, foscarnet, or cidofovir, and treatment should continue until immune recovery occurs, typically requiring CD4 counts above 100-150 cells/μL for at least 3-6 months in HIV patients 1. The choice of initial therapy for CMV retinitis should be individualized based on the location and severity of the lesion(s), the level of underlying immune suppression, and other factors such as concomitant medications and ability to adhere to treatment 1.
- Induction therapy options include:
- Intravenous ganciclovir (5 mg/kg every 12 hours for 14-21 days)
- Valganciclovir (900 mg twice daily for 21 days)
- Foscarnet (60 mg/kg every 8 hours or 90 mg/kg every 12 hours for 14-21 days)
- Cidofovir (5 mg/kg once weekly for 2 weeks)
- Maintenance therapy options include:
- Valganciclovir (900 mg once daily)
- Oral ganciclovir (1000 mg three times daily)
- Reduced doses of IV medications
- For localized disease, intravitreal injections of ganciclovir (2 mg/0.1 mL weekly) or foscarnet (2.4 mg/0.1 mL weekly) may be used 1. Regular ophthalmologic examinations are essential to monitor treatment response, and kidney function should be monitored due to potential nephrotoxicity of these medications 1. Immune reconstitution with antiretroviral therapy in HIV patients is crucial for long-term management 1.
From the FDA Drug Label
- 1 Adult Patients Treatment of Cytomegalovirus (CMV) Retinitis: Valganciclovir tablets, USP are indicated for the treatment of CMV retinitis in patients with acquired immunodeficiency syndrome (AIDS) 2.2 Recommended Dosage in Adult Patients with Normal Renal Function For dosage recommendations in adult patients with renal impairment [see Dosage and Administration ( 2. 5)]. Treatment of CMV Retinitis: • Induction: The recommended dosage is 900 mg (two 450 mg tablets) taken orally twice a day for 21 days. • Maintenance: Following induction treatment, or in adult patients with inactive CMV retinitis, the recommended dosage is 900 mg (two 450 mg tablets) taken orally once a day
The recommended treatment for Cytomegalovirus (CMV) retinitis is valganciclovir.
- Induction dose: 900 mg (two 450 mg tablets) taken orally twice a day for 21 days.
- Maintenance dose: 900 mg (two 450 mg tablets) taken orally once a day. 2
From the Research
Treatment Options for CMV Retinitis
The treatment for Cytomegalovirus (CMV) retinitis typically involves antiviral medications. The choice of treatment depends on various factors, including the severity of the disease and the patient's overall health.
- Initial Treatment: The standard initial treatment for CMV retinitis has been ganciclovir or foscarnet, both of which are infused intravenously 3. However, valganciclovir, an oral medication, has been shown to be as effective as intravenous ganciclovir for initial treatment 3.
- Maintenance Treatment: Maintenance treatment is typically based on ganciclovir or foscarnet, but valganciclovir can also be used for maintenance therapy 3. Intraocular maintenance treatment is only suitable for patients with localized infections and a low risk of relapse.
- Combination Therapy: Combination therapy with foscarnet and ganciclovir has been shown to be effective in controlling CMV retinitis, particularly in patients who have relapsed 4.
- Oral Valganciclovir: Oral valganciclovir has been shown to be effective in treating CMV retinitis, including in patients with severe immunodeficiency 5.
Comparison of Treatment Options
Studies have compared the efficacy of different treatment options for CMV retinitis. For example:
- A study found that foscarnet and ganciclovir were equivalent in controlling CMV retinitis and preserving vision 6.
- Another study found that combination therapy with foscarnet and ganciclovir was more effective than monotherapy in controlling CMV retinitis 4.
- Foscarnet has been shown to be a useful alternative to ganciclovir, particularly when combined with bone marrow toxic drugs 7.
Adverse Effects
The adverse effects of treatment for CMV retinitis can vary depending on the medication used. For example: