Use of the ganciclovir implant for the treatment of cytomegalovirus retinitis in the era of potent antiretroviral therapy: Recommendations of the International AIDS Society - USA panel

(PURPOSE)-P-.: To describe the risks, benefits, and recommended use of the ganciclovir implant for the treatment of human immunodeficiency virus-relat ed cytomegalovirus (CMV) retinitis in the era of potent antiretroviral ther apy. (METHODS)-M-.: A panel of physicians with expertise in the use of the ganci clovir implant and in the management of CMV retinitis was convened by the I nternational AIDS Society-USA. The panel reviewed and discussed available d ata, and developed recommendations for the use of the ganciclovir implant, the surgical technique, and related management issues. Recommendations were rated according to the strength and quality of the supporting evidence. (RESULTS)-R-.: The effect of potent antiretroviral therapy on the immunolog ic status of patients with human immunodeficiency virus disease has changed the manifestation and course of CMV retinitis in many patients. The clinic al management of CMV retinitis and the role of the ganciclovir implant are thus changing. Factors in the decision to choose the ganciclovir implant in clude the patient's potential for immunologic improvement, location and sev erity of CMV retinitis, and the risks and costs associated with implantatio n and concomitant oral ganciclovir therapy. (CONCLUSIONS)-C-.: The ganciclovir implant is safe and effective for the tr eatment of CMV retinitis. The indications for its use should be modified to account for increased patient survival and the potential for CMV retinitis to be controlled by effective antiretroviral therapy. Optimal use of the g anciclovir implant and discontinuation of therapy in selected patients with improvement in immunity may result in better long-term visual outcomes. (C ) 1999 by Elsevier Science Inc. All rights reserved.