Effect of a 14-day course of foscarnet on cytomegalovirus (CMV) blood markers in a randomized study of human immunodeficiency virus-infected patientswith persistent CMV viremia

A randomized open-label phase 2 trial compared the virological and clinical effects on cytomegalovirus (CMV) infection of a 14-day course of intraveno us foscarnet (100 mg/[kg . 12 h]) or no treatment in 42 HIV-infected patien ts with <100 CD4 cells/mm(3) and persistent asymptomatic CMV viremia. All C MV markers (blood culture, pp65 antigenemia, plasma and leukocyte DNA) eith er became negative or decreased significantly at day 14 in the foscarnet gr oup. CMV brood culture results at day 14 were positive in 14% of those rece iving foscarnet versus 60% of control patients (P = .004). However, after t he end of treatment, all markers reappeared or the virus load rapidly incre ased. The probability of CMV disease at 6 months was 43% in both groups. Pa tients who had or who achieved a negative blood culture at any time had a r educed risk of CMV disease (RR = 2.64; 95% CI = 1.24-5.62; P = .02). This s tudy suggests that sequential courses of intravenous foscarnet might not be a good strategy for preemptive therapy in this population and that in pati ents with a positive blood marker, treatment able to induce and maintain ne gative CMV blood cultures could constitute an effective intervention.