New strategies for the management of AIDS-related CMV retinitis in the eraof potent antiretroviral therapy

The management of AIDS-related cytomegalovirus (CMV) retinitis is evolving because of newly available anti-CMV drugs and because of the effect of pote nt antiretroviral therapy. New management issues are related to the improve d immune function that occurs with antiretroviral drug use and to associate d increases in patient survival. Patients can be categorized on the basis o f their history of exposure to antiretroviral drugs and to their immune sta tus; these factors will influence choices between treatment options. In som e patients with improved immune function, specific anti-CMV therapy can be withdrawn altogether without reactivation of infection. There are curently many treatment options available for those who need specific anti-CMV treat ment: ganciclovir via various routes (intravenous (IV), oral, intraocular i mplant), IV foscarnet; IV cidofovir; intravitreous fomivirsen; or a combina tion of these agents. Previous short-term therapies are being adapted to th e long-term management of what has become a chronic disease. Management str ategies also involve appropriate monitoring for the recurrence of disease a ctivity and the development of complications, such as retinal detachment or immune recovery uveitis. This chapter provides an overview of new treatmen t strategies that will assist clinicians in choosing between treatment opti ons.