ORAL GANCICLOVIR AS MAINTENANCE TREATMENT FOR AIDS-RELATED CYTOMEGALOVIRUS RETINITIS FOLLOWING INDUCTION THERAPY

The choice of maintenance therapy for cytomegalovirus retinitis in AID S patients is made after analysing the relative risks and benefits of available strategies. Intravenous maintenance therapy with ganciclovir or foscarnet, although considered as the most potent strategy, is ass ociated with a significant toxicity, and intravenous access complicati ons. Furthermore, it does not really prevent but only delays retinitis progression or recurrence. Therefore, oral ganciclovir, which is less toxic and easier to use, seems more suitable as a maintenance therapy . The rate and delay of retinitis recurrence or progression are not si gnificantly different from those of intravenous therapy. Oral ganciclo vir can be proposed after an induction therapy using both intravenous ganciclovir and foscarnet. Induction foscarnet followed by maintenance oral ganciclovir offers the following additional advantages: absence of cross resistance or toxicity, use of different drugs for induction and for maintenance therapy. Whatever choice is made for maintenance t herapy, regular fundus examination is mandatory.