| Cytomegalovirus (CMV)
What is CMV?
CMV is short for cytomegalovirus. This virus commonly causes disease
in the eyes or the intestines (gut) in people with HIV. CMV infection
of the eyes is called CMV retinitis. It is the disease that most
often causes blindness in people with AIDS. CMV infection of the
colon is called CMV colitis. CMV can also attack your lungs, brain,
liver and other organs.
What are the signs of CMV?
People with CMV retinitis might have blurry vision, unusual changes
in eyesight or see small-moving spots called floaters. They may
also feel as if a shade is drawn over their eyes. People with CMV
colitis might have diarrhea, abdominal pain, weight loss, fevers,
loss of appetite, or trouble swallowing. In other parts of the body,
CMV can cause painful neuropathy (tingling in the hands or feet),
dementia or jaundice (yellow skin). If you have any of these signs,
you should see your doctor right away. Early diagnosis is important.
Can CMV be treated?
There are three drugs approved as treatments for CMV disease. These
drugs are ganciclovir (Cytovene), foscarnet (Foscavir) and cidofovir
(Vistide). These drugs will not cure CMV, but they can stop the
infection from getting worse.
Cytovene and Foscavir need to be infused (given by IV) daily,
over a period of two to four hours. You may need a tube called a
catheter implanted in your chest (a Hickman Catheter® - HICKMAN is a registered trademark
of C. R. Bard, Inc. and its related
company, BCR, Inc.) or your arm
(a PICC line) to make it easier to give the infusion. A catheter
may not be necessary with Vistide, since the drug is given as an
infusion every two weeks rather than every day.
Another way to treat CMV retinitis is to surgically insert a ganciclovir
implant (Vitrasert) into the infected eye. The implant is a small
plastic pellet that slowly releases ganciclovir for 6-8 months before
replacement is needed. The implant cannot protect against CMV in
the other eye or anywhere else.
Your doctor also may prescribe an oral form of ganciclovir. Ganciclovir
pills dont work as well as the infusions because the body does not
absorb them well. But once the infusions have slowed down CMV, the
oral drug keeps it in check almost as successfully.
Very often these drugs will not work well or will have side effects
that make you sick. If this happens, your doctor might change the
dose or switch or add drugs.
What are the side effects of the CMV treatments?
The most common side effect from infused or oral Cytovene is neutropenia
(low white blood cells). It is usually reversible if you stop taking
the drug. Neutropenia can also be treated with G-CSF (Neupogen)
and/or GM-CSF (Leukine). Both drugs are given by injection. Other
side effects of ganciclovir include anemia, fever, rash and abnormal
liver function.
Foscavir can cause serious kidney damage, nausea and skin sores.
It is very important to prevent infection by keeping catheters
clean and dry and regularly changing the bandages that cover them.
Infections around the catheter can be very dangerous and should
be treated immediately by your doctor.
Vistide can cause neutropenia and harm the kidneys. To protect
against life-threatening kidney damage, Vistide must be given with
an infusion of saline solution and an oral drug called probenecid.
Taking probenecid on the day of and the day after the infusion lessens
kidney toxicity. Side effects of probenecid include skin rash, headache,
nausea and fever.
All of these drugs require careful monitoring. It is especially
important for your doctor or nurse to check the health of your kidneys
if you are taking Vistide.
The ganciclovir implants (Vitrasert) cause fewer side effects
than other therapies. But there is a slight risk that the surgery
may damage the eye.
Ask your doctor about the following experimental treatments for
CMV:
Injection of drug directly into the eye, though this procedure
can be used with any of the approved drugs, it may work better with
cidofovir because cidofovir lasts longer than other drugs. A drawback
is that the procedure may injure the eye.
New drugs in early human trials include lobucavir, 1263W94 and
a better type of oral ganciclovir called valganciclovir.
Can CMV be prevented?
Most people are already infected with CMV, but the infection does
not make them sick, even if they have HIV. People who develop CMV
illness usually have a T-cell count less than 50. Effective anti-HIV
therapy may prevent CMV outbreaks by raising T-cell counts.
Studies disagree on whether the oral form of ganciclovir can prevent
CMV illness. Even if it does, most doctors believe that only people
most at risk for developing CMV should be given treatment with oral
ganciclovir because of its cost and side effects. Talk with your
doctor about whether or not preventive therapy with oral ganciclovir
is right for you.
Lobucavir, valganciclovir and adefovir (Preveon) may also prevent
CMV. Preveon fights HIV as well as CMV and is available free through
participation in a clinical study. For a clinical trial site near
you, call 1/800 TRIALS-A
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