Cytomegalovirus (CMV) Retinitis

Clinical Description

Affects up to 40% of people with AIDS with CD4 count ≤50 cells/mm3. In patients already on

HAART, consider drug failure or non-compliance. Uncommonly occurs in the absence of AIDS i.e., from relative immunosuppression from systemic corticosteroid use, chemotherapeutics etc.

Treatment

• Systemic treatment
• HAART: to regain CD4 count >50/mm3 which is an effective prophylaxis against CMV retinitis
• Anti CMV therapy
• Ganciclovir 5mg/kg IV EVERY 12HRS for 2-3 weeks, then 5mg/kg od during the induction phase. Oral Ganciclovir 300-450mg daily for prophylaxis and maintenance may be given when retinitis is stable until

CD4 count is more than 100-1S0 cells/μl. Ganciclovir is marrow toxic and hence the need for regular FBC checks.

• Foscarnet 90mg/kg every 12hrs for up to 2 weeks for induction and 90- 120mg od for maintenance.
• Foscarnet is nephrotoxic and causes electrolyte imbalances and seizures.
• Give Valganciclovir 900mg every 12hrs in the induction phase for 3 weeks, followed by maintenance therapy of 900mg every day
• Intravitreal treatment
• Ganciclovir 2 mg in 0.08ml
• Foscarnet 1.2-2.4 mg
• Give Ganciclovir intraocular implant (for long term treatment)