A RANDOMIZED, PLACEBO-CONTROLLED TRIAL OF THE SAFETY AND EFFICACY OF ORAL GANCICLOVIR FOR PROPHYLAXIS OF CYTOMEGALOVIRUS DISEASE IN HIV-INFECTED INDIVIDUALS
Cl. Brosgart et al., A RANDOMIZED, PLACEBO-CONTROLLED TRIAL OF THE SAFETY AND EFFICACY OF ORAL GANCICLOVIR FOR PROPHYLAXIS OF CYTOMEGALOVIRUS DISEASE IN HIV-INFECTED INDIVIDUALS, AIDS, 12(3), 1998, pp. 269-277
Objective: Evaluate safety and efficacy of oral ganciclovir (GCV) for
preventing cytomegalovirus (CMV) disease in HIV-infected persons at hi
gh risk for CMV disease. Design: Double-blind, placebo-controlled, ran
domized clinical trial in primary care clinics and private practice of
fices specializing in the care of people with HIV. Interventions were
oral GCV (1000 mg three times/day) or placebo. Protocol amendment allo
wed switch to open-label oral GCV. Main outcome measures were confirme
d CMV retinal or gastrointestinal mucosal disease, and death. The stud
y enrolled 994 people co-infected with CMV and HIV, with at least one
CD4 count recorded < 100 x 10(6) cells/l. Results: At study completion
(15 months median follow-up), CMV event rates in the oral GCV and con
trol groups were 13.1 and 14.6 per 100 person years, respectively, a h
azard ratio (HR) of 0.92 [95% confidence interval (CI), 0.65-1.27; P =
0.6]. At protocol amendment event rates were 12.7 and 15.0, respectiv
ely (HR, 0.85; 95% CI, 0.56-1.30; P = 0.45). At study completion, even
t rates for death were 26.6 and 32.0 (HR, 0.84; P = 0.09), and at prot
ocol amendment were 18.9 and 19.6 (HR, 0.95; P = 0.78), respectively.
At protocol amendment for the CMV endpoint, the oral GCV treatment eff
ect was associated with baseline use of didanosine (ddI). For patients
taking ddI at randomization, HR was 7.48 (P = 0.02). For patients not
taking ddI, HR was 0.62 (P = 0.04). These HR were statistically diffe
rent (P = 0.0006). Conclusions: In our study, 3 g/day oral GCV did not
significantly reduce CMV disease incidence, but there was a suggestio
n of a death-rate reduction. Furthermore, results suggest that oral GV
C decreased risk of CMV disease in patients not prescribed ddI, and in
creased risk in those prescribed ddI. For the CMV endpoint, our study
differs markedly from the only similar study, although for the death e
ndpoint, a combined analysis of studies indicated significant reductio
n in death rate.