COMBINED INTRAVENOUS GANCICLOVIR AND FOSCARNET FOR CHILDREN WITH RECURRENT CYTOMEGALOVIRUS RETINITIS

Purpose: Children with the acquired immune deficiency syndrome (AIDS) and cytomegalovirus (CMV) retinitis may not complain of symptoms despi te the presence of advanced sight-threatening disease. Although little data exist regarding CMV retinitis in this population, the treatment of this disease may be difficult because of frequent, extensive recurr ences after reduction of drug dose from induction to maintenance level s. The authors reported the results of the use of combined ganciclovir and foscarnet for treatment of recurrent CMV retinitis in three child ren with AIDS. Methods: Three children with recurrent CMV retinitis we re treated with combined ganciclovir and foscarnet administered intrav enously. All patients initially received induction dosages of ganciclo vir followed by maintenance therapy, at which time they experienced re activation of their disease. The dosing regimen for induction with the combined therapy was foscarnet (60 mg/kg every 8 hours) and ganciclov ir (5 mg/kg daily for 3 weeks), Maintenance with combined therapy cons isted of foscarnet (90 mg/kg daily) and ganciclovir (5 mg/kg daily). R esults: All patients showed complete healing of the retinitis during t he first 3 weeks of combined therapy. Median survival after initiation of combined therapy was 15 weeks(range, 12-33 weeks), None of the chi ldren experienced reactivation of CMV retinitis during combined therap y with ganciclovir and foscarnet. Combined therapy was well tolerated in all patients without major side effects. No patient required discon tinuation or interruption of either drug during combined therapy. Conc lusion: Children with recurrent CMV retinitis may not report visual sy mptoms, which can delay therapeutic intervention. Therefore, recurrent disease in children should be treated aggressively to avoid potential ly devastating visual loss. A combination of ganciclovir and foscarnet appears to be a safe and effective therapeutic option for treatment o f recurrent CMV retinitis in children with AIDS. This approach causes no additional toxic reactions and may provide improved long-term contr ol of recurrent CMV retinitis in children.