Induction and maintenance therapy of cytomegalovirus central nervous system infection in HIV-infected patients

作者：Beatrice Anduze‐Faris, Anne‐Marie Fillet, Joël Gozlan, Rémi Lancar, Narjis Boukli, Jacques Gasnault, Éric Caumes, Joël Livartowsky, Sophie Matheron, Catherine Leport, Dominique Salmon, Dominique Costagliola, Christine Katlama · 发表于：AIDS · 年份：2000 · DOI：10.1097/00002030-200003310-00007 · 被引用次数：113 · 研究领域：Cytomegalovirus and herpesvirus research、HIV Research and Treatment、Herpesvirus Infections and Treatments

OBJECTIVE: To evaluate the efficacy and safety of the foscarnet-ganciclovir combination in induction therapy (IT) and maintenance therapy (MT) for cytomegalovirus (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 antiretroviral therapy (HAART) received intravenous IT with foscarnet 90 mg/kg plus ganciclovir 5 mg/kg twice a day followed by MT. The primary endpoint was clinical 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 did not respond clinically. Side-effects leading to drug discontinuation occurred in 10 patients during IT. Among the 23 patients who qualified for the maintenance phase, CMV disease progressed in 10, with a median time to the first relapse of 126 days (range 64-264 days). Overall, the median survival 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 stabilization in 74% of patients. Life-long MT with this combination is recommended as long as the immune system is profoundly impaired.