TREATMENT OF AIDS-ASSOCIATED GASTROINTESTINAL CYTOMEGALOVIRUS-INFECTION WITH FOSCARNET AND GANCICLOVIR - A RANDOMIZED COMPARISON

Patients with symptomatic gastrointestinal disease due to cytomegalovi rus (CMV) were randomized to receive open-label ganciclovir (22) or fo scarnet (26). Patients were stratified by disease site and concurrent gut infection. Response was assessed by a visual analogue score of sym ptoms, endoscopic appearances, histologic inflammation, and numbers of CMV inclusions. In each treatment group, 73% had a complete or good c linical response; 83% of foscarnet-treated and 85% of ganciclovir-trea ted patients showed response by endoscopy, and inclusion bodies disapp eared from follow-up biopsies in 73% of these. Most patients (35) deve loped further evidence of CMV disease during follow-up. The time to pr ogression was not significantly different between recipients (16 weeks ) and nonrecipients (13 weeks) of maintenance therapy, although patien ts were not randomized to receive maintenance or not. Survival in both treatment groups was <40 weeks and was unaffected by maintenance trea tment, Both ganciclovir and foscarnet are effective first-line treatme nts for gastrointestinal (GI) CMV infection. Maintenance therapy does not prevent progression of disease.