Bm. Anduze-faris et al., Induction and maintenance therapy of cytomegalovirus central nervous system infection in HIV-infected patients, AIDS, 14(5), 2000, pp. 517-524
Objective: To evaluate the efficacy and safety of the foscarnet-ganciclovir
combination in induction therapy (IT) and maintenance therapy (MT) for cyt
omegalovirus (CMV) central neurological disorders in HIV-infected patients.
Design: An open pilot non-comparative multicentre study.
Methods: Thirty-one patients with acute CMV encephalitis (CMVe) (n = 17) or
CMV myelitis (CMVm) (n =14) during the era before highly active antiretrov
iral therapy (HAART) received intravenous IT with foscarnet 90 mg/kg plus g
anciclovir 5 mg/kg twice a day followed by MT. The primary endpoint was cli
nical efficacy, assessed at the end of the induction phase.
Results: The foscarnet-ganciclovir combination in IT resulted in a 74% (23
out of 31 patients) clinical improvement or stabilization. Eight patients d
id not respond clinically. Side-effects leading to drug discontinuation occ
urred in 10 patients during IT. Among the 23 patients who qualified for the
maintenance phase, CMV disease progressed in 10, with a median rime to the
first relapse of 126 days (range 64-264 days). Overall, the median surviva
l time was 3 months [95% confidence interval (CI), 2-4 months].
Conclusion: The combination of foscarnet and ganciclovir can safely be used
for CMV central nervous system (CNS) infection, with an improvement or sta
bilization in 74% of patients. Life-long MT with this combination is recomm
ended as long as the immune system is profoundly impaired. (C) 2000 Lippinc
ott Williams & Wilkins.