Original Article
Oral Ganciclovir for the Prevention of Cytomegalovirus Disease in Persons with AIDS
N Engl J Med 1996; 334:1491-1497June 6, 1996
- Abstract
Background
In the advanced stages of the acquired immunodeficiency syndrome (AIDS), cytomegalovirus (CMV) disease, particularly vision-damaging retinitis due to CMV, is common. We evaluated prophylactic treatment with orally administered ganciclovir as a way to prevent CMV disease.
Methods
We conducted a prospective, randomized, double-blind, placebo-controlled study of CMV-infected persons with AIDS with either CD4+ lymphocyte counts of <50 per cubic millimeter or counts of <100 per cubic millimeter in those with a history of an AIDS-defining opportunistic infection. Patients were randomly assigned, in a 2:1 ratio, to receive either oral ganciclovir (1000 mg three times daily) or placebo.
Results
The study was stopped after a median of 367 days of follow-up. In an intention-to-treat analysis, the 12-month cumulative rates of confirmed CMV disease were 26 percent in the placebo group (n = 239) and 14 percent in the ganciclovir group (n = 486), representing an overall reduction in risk of 49 percent in the ganciclovir group (P<0.001). The incidence of CMV retinitis after 12 months was 24 percent in the placebo group and 12 percent in the ganciclovir group (P<0.001). The prevalence of CMV-positive urine cultures at base line was 42 percent; after two months it was 43 percent in the placebo group and 10 percent in the ganciclovir group (P<0.001). The one-year mortality rate was 26 percent in the placebo group and 21 percent in the ganciclovir group (P = 0.14). Therapy with granulocyte colony-stimulating factor was more frequent in the ganciclovir group (24 percent) than in the placebo group (9 percent).
Conclusions
In persons with advanced AIDS, prophylactic oral ganciclovir significantly reduces the risk of CMV disease.
Media in This Article
Figure 2
Prevalence of CMV-Positive Urine Cultures in the Ganciclovir and Placebo Groups.Figure 1
Kaplan–Meier Curves of Survival without Confirmed, Protocol-Defined CMV Disease (Panel A), Overall Survival (Panel B), and Survival without CMV Disease (Panel C) in the Ganciclovir Group (N = 486) and the Placebo Group (N = 239).Article Activity
- Article
Human cytomegalovirus (CMV) is an important pathogen in persons with the acquired immunodeficiency syndrome (AIDS), and at autopsy as many as 90 percent of patients with AIDS have evidence of CMV infection.1-5 CMV retinitis affects 25 to 40 percent of those with AIDS2-7; other diseases related to CMV in patients with AIDS include gastrointestinal disease, encephalitis, polyradiculitis, and, less frequently, pneumonia.2-5,8-10 CMV is also an important pathogen in other immunocompromised people, including recipients of organ transplants, persons with cancer, and congenitally infected infants.11
Currently, two antiviral agents, ganciclovir and foscarnet, are approved for the treatment of some CMV-related conditions.12-16 Despite treatment, however, CMV disease, and particularly CMV retinitis, tends to recur; retinitis may progress and result in the loss of vision. Both ganciclovir and foscarnet must be administered intravenously in the initial treatment of active CMV disease, and long-term intravenous treatment necessitates placement of a central venous catheter.
Studies of the bioavailability of oral ganciclovir have demonstrated that the plasma levels attained are sufficient to inhibit the growth in vitro of most clinically important strains of CMV.17 Oral ganciclovir has also been shown to be effective as maintenance therapy for patients with AIDS who have newly diagnosed, as well as recurrent, CMV retinitis.18,19
Considerable progress has been made in the prevention of opportunistic infections in people with AIDS, including Pneumocystis carinii pneumonia, disease caused by the Mycobacterium avium complex, and serious fungal infections.4,20-24 The high frequency of CMV disease in patients with AIDS makes prophylaxis against the condition a high priority. In this study we evaluated the safety and efficacy of oral ganciclovir in the prevention of CMV disease in persons with AIDS.
Methods
Study Design
The study protocol was reviewed and approved by the appropriate local institutional review boards, and all participants gave written informed consent. The study subjects were adults infected with the human immunodeficiency virus (HIV) who had had two CD4+ lymphocyte counts performed in the 30 days before entry into the study that were <50 cells per cubic millimeter or, in those with a documented history of an AIDS-defining opportunistic infection, were <100 per cubic millimeter.25 All subjects had CMV infection, confirmed by antibody test or urine culture. Patients were ineligible if they had past or present CMV disease or a history of treatment for CMV, active gastrointestinal disease, an absolute neutrophil count below 750 cells per cubic millimeter, a platelet count below 50,000 per cubic millimeter, an estimated creatinine clearance rate below 70 ml per minute, or a score below 60 on the Karnofsky scale.
At base line, all study subjects underwent a complete history taking, a physical examination, and an ophthalmologic examination. Base-line laboratory evaluations included complete and differential blood counts, an analysis of serum chemistry, determination of T-cell–subgroup levels, and a urine culture for CMV. Experienced ophthalmologists performed dilated-eye examinations in order to exclude patients with CMV retinitis before randomization.
After stratification according to base-line CD4+ lymphocyte count (<50 or >50 per cubic millimeter), subjects were randomly assigned, in a 2:1 ratio, to receive either 1000 mg of ganciclovir (in 250-mg capsules) or a matched placebo three times a day with food. Subjects were evaluated on the 14th day after the start of treatment and then at 2-month intervals during treatment. At each study visit, a limited interim history was taken, and a physical examination and laboratory tests were performed. Every two months, an examination of the subjects' dilated eyes was performed by an experienced ophthalmologist, and urine was obtained for CMV culture.
Antiretroviral therapy was recommended for all subjects. Therapy with oral acyclovir was allowed, in doses of no more than 1000 mg per day, for the suppression of recurrent infection with herpes simplex virus. Higher doses of acyclovir for the treatment of acute herpesvirus infection were allowed up to a maximum of four weeks of oral acyclovir or two weeks of intravenous acyclovir.
End Points
The primary study end point was the development of confirmed CMV disease according to defined criteria. The presence of CMV retinitis was determined through examination of the fundus of the dilated eye and through indirect ophthalmoscopy by ophthalmologists experienced in the diagnosis of the condition. Summaries describing all extraocular episodes of CMV disease were reviewed independently by the study chairperson and a clinical reviewer not associated with the study, both of whom were unaware of the subjects' treatment assignments.
A diagnosis of CMV gastrointestinal disease was confirmed by the presence of signs and symptoms of disease in the upper or lower gastrointestinal tract and by endoscopy with biopsy. The biopsy had to reveal the presence of cells with CMV inclusions or evidence of CMV on immunostaining, immunofluorescence, or in situ hybridization; inflammation or necrosis; and the absence of other pathogens. A diagnosis of CMV pneumonia required confirmation by either open-lung biopsy or transbronchial lung biopsy. The lung biopsy had to reveal cells with CMV inclusions, or the tissue had to test positive for CMV on immunostaining, immunofluorescence, or in situ hybridization; in addition, there had to be no evidence of P. carinii or other pathogens. At least two of the following were also required for a confirmed diagnosis of CMV pneumonia: interstitial infiltrates seen on chest x-ray films, dyspnea, a need for supplemental oxygen or ventilatory assistance, and decreased partial pressure of oxygen. The diagnosis of CMV polyradiculopathy required confirmation of CMV in the cerebrospinal fluid by culture or the polymerase chain reaction, as well as progressive flaccid paraparesis, polymorphonuclear pleocytosis, and decreased glucose levels and elevated protein in the cerebrospinal fluid. Other types of CMV disease required confirmation by biopsy and had to fulfill the histopathological and virologic criteria described above.
Statistical Analysis
The study was designed to have a power of 90 percent to detect a reduction of at least 50 percent in the incidence of CMV disease after 18 months of treatment, with an expected incidence of CMV disease of 30 percent in the placebo group and 15 percent in the ganciclovir group. Two interim analyses were scheduled to be reviewed by an independent Data and Safety Monitoring Board that would use the O'Brien–Fleming boundary as the criterion for early termination of the study.26,27 We used Kaplan–Meier analysis to compute rates of CMV disease in the placebo and ganciclovir groups.28 The time to the development of CMV disease in the two study groups was compared with the stratified log-rank test, and the groups were stratified according to base-line CD4+ lymphocyte counts. Relative risks, reductions in risk, and 95 percent confidence intervals were computed with a stratified Cox proportional-hazards analysis. We used Fisher's exact test to compare proportions in the study groups. All tests were two-sided.
Results
A total of 725 subjects were enrolled at 19 sites from November 1992 through December 1993. The randomized portion of the study ended on July 15, 1994, after the review of the first interim analysis by the Data and Safety Monitoring Board determined that the criteria for stopping the trial had been satisfied. All subjects were then offered open-label ganciclovir. the analysis of survival included all deaths of study subjects through August 18, 1994, the earliest date on which subjects could have started open-label treatment. For the primary analyses of efficacy and survival, all subjects randomly assigned to the study groups were included according to intention-to-treat criteria. In the secondary analyses of efficacy and safety, all subjects who actually received study medication were included.
Study Population
Of the 725 subjects, 486 were randomly assigned to therapy with oral ganciclovir and 239 to placebo. Thirteen subjects, eight assigned to the ganciclovir group and five to placebo, never received study medication. The majority of subjects were white (82 percent) and male (99 percent). CMV infection was confirmed by serologic testing in 90 percent of the subjects, by urine culture in 6 percent, and by both in 4 percent. The mean age was 39 years, and the median CD4+ lymphocyte count was 22 per cubic millimeter. In the month before entry into the study, 94 percent of the subjects had received antiretroviral medication; 54 percent of the subjects had had an AIDS-defining opportunistic infection. Base-line characteristics were similar in both treatment groups (Table 1Table 1
Base-Line Characteristics of the Subjects, According to Study Group.).The mean duration of treatment with ganciclovir was 269 days (median, 265), as compared with 240 days (median, 244) for placebo. Of the subjects, 33 percent in the ganciclovir group and 27 percent in the placebo group were treated for more than 365 days (maximum, 621 days in the ganciclovir group and 618 days in the placebo group). The mean length of observation from randomization through July 15, 1994, including follow-up, was 355 days (median, 372) for the ganciclovir group and 343 days (median, 360) for the placebo group.
CMV Disease
Kaplan–Meier estimates of the rate of protocol-defined CMV events at 12 months were 26 percent in the placebo group and 14 percent in the ganciclovir group, producing an overall reduction in risk of 49 percent (relative risk, 0.51; 95 percent confidence interval, 0.36 to 0.73; P<0.001) (Figure 1AFigure 1
Kaplan–Meier Curves of Survival without Confirmed, Protocol-Defined CMV Disease (Panel A), Overall Survival (Panel B), and Survival without CMV Disease (Panel C) in the Ganciclovir Group (N = 486) and the Placebo Group (N = 239). and Table 2Table 2
Incidence of CMV Disease in the Study Groups at 12 and 18 Months, According to Kaplan–Meier Estimates of Protocol-Defined and Investigator-Reported Events.). The rate of investigator-reported CMV events at 12 months was 33 percent in the placebo group and 18 percent in the ganciclovir group (relative risk, 0.50; 95 percent confidence interval, 0.37 to 0.69; P<0.001) (Table 2).CMV retinitis was the most frequent and usually the first type of CMV disease in both study groups. The 12-month incidence of CMV retinitis was 24 percent in the placebo group and 12 percent in the ganciclovir group (P<0.001). The 12-month incidence of protocol-defined colitis was 2 percent in both groups (P = 0.50). The 12-month incidence of investigator-reported colitis was 7 percent in the placebo group and 3 percent in the ganciclovir group (P = 0.003).
Only 12 percent of the study subjects randomly assigned to treatment (85 of 725) had a base-line CD4+ lymphocyte count greater than 50 per cubic millimeter. In this subgroup, prophylaxis with ganciclovir was associated with a significant reduction in the rate of development of CMV disease (relative risk, 0.24; 95 percent confidence interval, 0.07 to 0.84; P = 0.02). Similarly, ganciclovir significantly reduced the risk of CMV disease in 640 subjects with base-line CD4+ lymphocyte counts of <50 per cubic millimeter (relative risk, 0.55; 95 percent confidence interval, 0.38 to 0.79; P = 0.001).
Ganciclovir decreased the risk of CMV disease regardless of the concomitant use of antiretroviral agents. Ganciclovir was associated with a significant reduction in the incidence of CMV disease in the 631 subjects receiving antiretroviral therapy (relative risk, 0.57; 95 percent confidence interval, 0.39 to 0.83; P = 0.003) and in the 94 subjects not receiving antiretroviral agents (relative risk, 0.30; 95 percent confidence interval, 0.11 to 0.80; P = 0.01). The concomitant use of acyclovir also did not affect the efficacy of ganciclovir prophylaxis. The risk of CMV disease was reduced by treatment with ganciclovir both among the 468 subjects who received concomitant oral acyclovir (relative risk, 0.57; 95 percent confidence interval, 0.38 to 0.86; P = 0.007) and among the 257 subjects who did not receive acyclovir (relative risk, 0.42; 95 percent confidence interval, 0.22 to 0.81; P = 0.007).
Cultures for CMV
At base line, urine cultures were positive for CMV in 44 percent of the placebo group and 41 percent of the ganciclovir group; two months after the start of treatment, the proportions were 43 percent and 10 percent, respectively (P<0.001) (Figure 2Figure 2
Prevalence of CMV-Positive Urine Cultures in the Ganciclovir and Placebo Groups.). This significant difference between the study groups in the proportion of urine cultures positive for CMV was sustained throughout treatment. A CMV-positive culture at base line was associated with an increased risk of CMV disease (relative risk, 2.5 and 1.9 for the placebo and ganciclovir groups, respectively), and prophylaxis with ganciclovir reduced the risk of CMV disease regardless of the results of the base-line urine culture. Subjects with CMV-positive base-line cultures who received placebo had a 12-month incidence of protocol-defined CMV disease of 32 percent, as compared with 17 percent for subjects with CMV-positive cultures who received ganciclovir (relative risk, 0.56; 95 percent confidence interval, 0.33 to 0.97; P = 0.04). Subjects with CMV-negative cultures at base line who received placebo had a 12-month incidence of CMV disease of 22 percent, as compared with 11 percent among ganciclovir recipients with negative base-line cultures (relative risk, 0.49; 95 percent confidence interval, 0.28 to 0.83; P = 0.007).Clinical Events Related to HIV
In the study, a new HIV-related event was defined as a condition of which there was no previous history and that was not present at base line. the incidence of herpes simplex virus disease was 7 percent in the placebo group and 3 percent in the ganciclovir group (P<0.01); that of herpes zoster, 1 percent in the placebo group and 2 percent in the ganciclovir group; and that of oral hairy leukoplakia, 8 percent in the placebo group and 6 percent in the ganciclovir group. No significant differences between the placebo and ganciclovir groups were observed in the 12-month Kaplan–Meier estimates of invasive candidiasis (7 percent in the placebo group and 8 percent in the ganciclovir group), cryptococcal infection (1 percent and 1 percent), mycobacterial infection (11 percent and 10 percent), P. carinii pneumonia (10 percent and 12 percent), or toxoplasmosis (2 percent and 3 percent). Also, the incidence of Kaposi's sarcoma (12 percent in the placebo group and 8 percent in the ganciclovir group), non-Hodgkin's lymphoma (2 percent and 3 percent), wasting syndrome (3 percent and 5 percent), AIDS dementia complex (4 percent and 2 percent), and progressive multifocal leukoencephalopathy (2 percent and 1 percent) did not differ significantly between the two groups. The mean CD4+ lymphocyte counts 12 months after the start of treatment were 14 cells per cubic millimeter in the placebo group and 12 cells per cubic millimeter in the ganciclovir group.
Survival and Survival Free of CMV Disease
At 12 months the Kaplan–Meier estimate of the rate of death was 26 percent in the placebo group and 21 percent in the ganciclovir group (relative risk, 0.81; 95 percent confidence interval, 0.61 to 1.07; P = 0.14) (Figure 1B). The predominant cause of death in both groups was progressive HIV-related disease. The relative risk of death in the ganciclovir group, as compared with the placebo group, was similar in the two strata of base-line CD4+ lymphocyte counts. Ganciclovir prophylaxis did significantly improve survival free of CMV disease (Figure 1C). The 12-month Kaplan–Meier estimate of CMV disease or death was 43 percent in the placebo group and 29 percent in the ganciclovir group (relative risk, 0.65; 95 percent confidence interval, 0.51 to 0.84; P<0.001).
Adverse Events and Discontinuation of the Study Drug
Of the 725 study subjects, 446 (62 percent) discontinued the study medication during the study period — 158 (66 percent) in the placebo group and 288 (59 percent) in the ganciclovir group. Reasons for discontinuation of the study drug were the development of CMV disease (26 percent of the placebo group and 13 percent of the ganciclovir group), adverse events (16 percent and 19 percent), death (4 percent and 6 percent), withdrawal from the study (11 percent and 10 percent), administrative problems (5 percent and 5 percent), and loss to follow-up (2 percent and 3 percent).
Gastrointestinal symptoms were the most commonly reported adverse events, occurring in 74 percent of the placebo group and 77 percent of the ganciclovir group (Table 3Table 3
Incidence of Selected Adverse Events According to Study Group.). Severe gastrointestinal symptoms were reported in 14 percent of the placebo group and 15 percent of the ganciclovir group. Neuropathy occurred in 15 percent of the placebo group and 21 percent of the ganciclovir group (P = 0.09) and was severe in 2 percent of each group. Severe neutropenia, defined as an absolute neutrophil count below 500 cells per cubic millimeter, occurred in 6 percent of the placebo group and 10 percent of the ganciclovir group (P = 0.1). Severe anemia, defined as a hemoglobin concentration below 8 g per deciliter, was reported in 4 percent of the placebo group and 5 percent of the ganciclovir group. Granulocyte colony-stimulating factor was given to 24 percent of the ganciclovir group and 9 percent of the placebo group (P<0.001). The duration of treatment per person-year was 16 days in the placebo group and 47 days in the ganciclovir group. Similarly, treatment with erythropoietin was more frequent in the ganciclovir group than in the placebo group (14 percent vs. 6 percent, P<0.01). The number of days of treatment with erythropoietin per person-year of treatment with the study drug was 17 days in the placebo group and 26 days in the ganciclovir group. A maximal serum creatinine concentration of 1.5 mg per deciliter (133 μmol per liter) or more was reached in 21 percent of the ganciclovir group and 13 percent of the placebo group (P = 0.03). A maximal creatinine concentration above 2.5 mg per deciliter (221 μmol per liter) occurred in 1 percent of the ganciclovir group and 2 percent of the placebo group.Discussion
Currently, CMV is the most common serious opportunistic pathogen in persons with AIDS for which no effective prophylaxis is available. Intravenous ganciclovir administered prophylactically has successfully reduced the incidence of CMV disease after bone marrow or solid-organ transplantation.29,30 However, because the risk of CMV disease progressively increases as HIV disease advances, intravenous prophylaxis for persons with AIDS would require the placement of a central venous catheter for its prolonged use, an impractical procedure that would be unacceptable to most patients. Our study demonstrates that in persons with advanced AIDS, an average of 9 months of prophylaxis with oral ganciclovir decreased the rate of CMV disease by approximately 50 percent during approximately 12 months of observation. As expected, CMV retinitis was the most frequent event and the form of CMV disease most markedly affected by oral ganciclovir. However, the rate of CMV colitis may also have decreased in the subjects receiving ganciclovir. More cases of colitis were reported by investigators than met the definition in the study protocol (Table 2), and the beneficial effect of ganciclovir was more marked in the investigator-reported cases. This discrepancy may reflect the difficulty of establishing the diagnosis of many CMV diseases other than retinitis. The subjects who met the strict criteria of this study for the diagnosis of CMV disease may represent only a portion of those who actually had CMV disease.
Preliminary results of another study, Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA 023), have suggested that oral ganciclovir may not be effective in preventing CMV disease in persons with AIDS.31 However, several important differences exist between the CPCRA study and our own. Persons enrolled in the CPCRA study had a median CD4+ lymphocyte count 67 percent higher than that of the subjects in our study, and follow-up during randomized drug therapy was shorter. Most important, dilated-eye examinations by an ophthalmologist were not required before entry into the CPCRA study or during the study unless visual symptoms were reported. Thus, participants in the CPCRA study could have entered the trial with unrecognized CMV retinitis or retinitis could have developed unrecognized during the study period.
Our study found a significant decline from base line in the prevalence of CMV-positive urine cultures in the ganciclovir group, as compared with the placebo group. This virologic response to oral ganciclovir strongly suggests a beneficial clinical effect. Moreover, the presence of infectious virus, as seen in urine cultures, was associated with an increased risk of subsequent CMV disease.
Severe adverse events were uncommon in the subjects who received oral ganciclovir. Gastrointestinal symptoms, although common, were not significantly more frequent in the ganciclovir group than in the placebo group. The most common adverse events in the ganciclovir group — as seen in laboratory testing — included neutropenia, anemia, and mild increases in serum creatinine concentrations. Subjects in the ganciclovir group used hematopoietic stimulating factors, including granulocyte colony-stimulating factor and erythropoietin, more often than those in the placebo group. However, the use of these growth factors was specifically encouraged in the study protocol to help subjects continue to take the study drug.
Our findings must be applied to the care of persons infected with HIV in the light of the specific characteristics of the study population. Although persons with CD4+ lymphocyte counts between 50 and 100 per cubic millimeter could have been enrolled in the study if they had had an AIDS-defining opportunistic infection, only 12 percent of study subjects were in this category. Therefore, our data came mostly from persons with CD4+ lymphocyte counts below 50 per cubic millimeter (median, 22 per cubic millimeter). Thus, CMV-positive persons with AIDS and CD4+ lymphocyte counts below 50 per cubic millimeter may be good candidates for prophylaxis with oral ganciclovir. However, ganciclovir also benefited the subgroup of subjects who had CD4+ lymphocyte counts of 51 to 100 per cubic millimeter. Although CMV-positive urine cultures were associated with a greater risk of CMV disease, CMV disease developed in some subjects in each study group even though they had persistently negative results on urine cultures. It is possible that emerging techniques for the rapid and sensitive detection of CMV32,33 will help to identify patients who are at highest risk for CMV disease.
Our study demonstrates that oral ganciclovir can significantly decrease the risk of CMV disease in persons with advanced AIDS. Although prophylaxis with ganciclovir was not associated with improved overall survival, survival free of CMV disease was significantly prolonged. Ganciclovir is generally well tolerated, but some patients will require hematopoietic stimulating factors for the treatment of neutropenia and anemia. Oral ganciclovir promises to be a useful drug for prophylaxis against CMV disease in persons with AIDS.
Supported by a grant from Roche pharmaceuticals (formerly Syntex Research).
Source Information
From the University of California, San Diego, La jolla (S.A.S., D.V.H.); St. Luke's–Roosevelt Hospital, New York (G.F.M.); the University of California, San Francisco, and Mount Zion Medical Center, San Francisco (J.P.L.); Methodist Hospital, Houston (T.S.); Oaklawn Physicians Group, Dallas (R.A.); R.K. Davies Medical Center, San Francisco (S.F.); Community Research Initiative of South Florida, Coral Gables (P.D.S.); Harbor–UCLA Medical Center, Torrance, Calif. (G.S.); and Roche Pharmaceuticals, Palo Alto, Calif. (W.B., R.W., M.J.S.).
Address reprint requests to Dr. Spector at the University of California, San Diego, Clinical Sciences Building, 9500 Gilman Dr., La Jolla, CA 92093-0672.
Other members of the Roche Cooperative Oral Ganciclovir Study Group are listed in the Appendix.
Appendix
In addition to the authors, the members of the Roche Cooperative Oral Ganciclovir Study Group are L. Meixner and W.R. Freeman (University of California, San Diego); M. Giordano and M.-H. Heinemann (Cornell Medical Center, New York); D.N. Friedberg and A. McMeeking (New York University Medical Center, New York); M. Thompson (AIDS Research Consortium of Atlanta); M.H. Grieco and S. Plotycia (St. Luke's–Roosevelt Hospital, New York); W.L. Drew, J. Sayre, and D. Miner (Mt. Zion Medical Center, University of California, San Francisco); A. Stein (Community Research Initiative of South Florida, Coral Gables); P.c. Jensen (Veterans Affairs Medical Center, San Francisco); P. Kumar and J. Lavelle (Georgetown University Hospital, Washington, D.C.); C.S. Crumpacker, D.V. Ives, and M.A. Laureano (Beth Israel Hospital, Harvard Medical School, Boston); M. Braffman (Pennsylvania Hospital, Philadelphia); D. McMahon (University of Pittsburgh, Pittsburgh); C.a. Benson, D. Samano, and T. Deutsch (Rush Medical College, Chicago); C.L. Brosgart, N.A. Orcutt, and R. Sorenson (East Bay AIDS Center, Berkeley, Calif.); B. McNamara and L. Savan (Kraus–Beer Medical Group, Los Angeles); M. Guerrero and P. Miller (Harbor–UCLA Medical Center, Torrance, Calif.); and A. Shadman (Roche Pharmaceuticals, Palo Alto, Calif.).
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- Citing Articles (102)
Citing Articles
1
W. P. Tsai, M. H. Chen, M. H. Lee, K. H. Yu, M. W. Wu, L. B. Liou. (2011) Cytomegalovirus infection causes morbidity and mortality in patients with autoimmune diseases, particularly systemic lupus: in a Chinese population in Taiwan. Rheumatology International
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M Nelson, H Manji, E Wilkins. (2011) 2 Central nervous system opportunistic infections. HIV Medicine 12, 8-24
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E Boffi El Amari, C Combescure, S Yerly, A Calmy, L Kaiser, B Hasse, H Furrer, M Cavassini, P Vernazza, HH Hirsch, E Bernasconi, B Hirschel, . (2011) Clinical relevance of cytomegalovirus viraemia*,†. HIV Medicine 12:7, 394-402
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Soren Gantt, Corey Casper. (2011) Human herpesvirus 8-associated neoplasms. Current Opinion in Infectious Diseases 24:4, 295-301
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Dirk Meyer-Olson, Reinhold E Schmidt, Benjamin A Bollmann. (2010) Treatment and prevention of cytomegalovirus-associated diseases in HIV-1 infection in the era of HAART. HIV Therapy 4:4, 413-436
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William J. Britt. 2010. Betaherpesviruses: Cytomegalovirus, Human Herpesviruses 6 and 7. .
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Raymund R Razonable. (2010) Immune-based therapies for cytomegalovirus infection. Immunotherapy 2:1, 117-130
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Lian Jin Liu, Jin Cheol Yoo, Joon Hee Hong. (2009) Short Synthesis and Antiviral Activity of Acyclic Phosphonic Acid Nucleoside Analogues. Nucleosides, Nucleotides and Nucleic Acids 28:2, 150-164
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(2008) Synthesis of Methyl-substituted Bicyclic Carbanucleoside Analogs as Potential Antiherpetic Agents. Bulletin of the Korean Chemical Society 29:10, 1977-1982
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José M. Miró. (2008) Prevención de las infecciones oportunistas en pacientes adultos y adolescentes infectados por el VIH en el año 2008. Enfermedades Infecciosas y Microbiología Clínica 26:7, 437-464
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Peshang Abdulhannan, Ian D Sugarman, Philip Wood, John WL Puntis. (2008) Primary CMV Colitis in an Immunocompetent Infant, Successfully Treated by Gancyclovir. Journal of Pediatric Gastroenterology and Nutrition 47:2, 203-205
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W. Lawrence Drew, Kim S. Erlich. 2008. Management of Herpesvirus Infections (Cytomegalovirus, Herpes Simplex Virus, and Varicella-Zoster Virus). , 437-461.
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Gary N. Holland, Jean D. Vaudaux, Samuel M. Jeng, Fei Yu, David T. Goldenberg, Ina-Caren Folz, William G. Cumberland, Colin A. McCannel, Craig J. Helm, W. David Hardy. (2008) Characteristics of Untreated AIDS-related Cytomegalovirus Retinitis. I. Findings before the Era of Highly Active Antiretroviral Therapy (1988 to 1994). American Journal of Ophthalmology 145:1, 5-11.e10
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Hyung Ryong Moon, Ah-Young Park, Kyung Ran Kim, Moon Woo Chun, Lak Shin Jeong. (2007) Synthesis of Enantiopure Pseudo-l-Vinylcyclopropyl Nucleosides Bearing Quaternary Carbon as Potential Anti-Herpesvirus Agent. Nucleosides, Nucleotides and Nucleic Acids 26:8-9, 975-978
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Ah-Young Park, Hyung Ryong Moon, Kyung Ran Kim, Moon Woo Chun, Lak Shin Jeong. (2007) Asymmetric Synthesis of Novel Pseudo-d-Vinylcyclopropyl Nucleosides Bearing Quaternary Carbon as Potential Anti-Herpesvirus Agent. Nucleosides, Nucleotides and Nucleic Acids 26:8-9, 1001-1004
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Viral Kansara, Yi Hao, Ashim K. Mitra. (2007) Dipeptide Monoester Ganciclovir Prodrugs for Transscleral Drug Delivery: Targeting the Oligopeptide Transporter on Rabbit Retina. Journal of Ocular Pharmacology and Therapeutics 23:4, 321-334
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Albert J Eid, Raymund R Razonable. (2007) Valganciclovir for the treatment of cytomegalovirus retinitis in patients with AIDS. Expert Review of Ophthalmology 2:3, 351-361
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Masami Takei, Kenji Yamakami, Ko Mitamura, Noboru Kitamura, Yoshihiro Matsukawa, Shigemasa Sawada. (2006) A case of systemic lupus erythematosus complicated by alveolar hemorrhage and cytomegalovirus colitis. Clinical Rheumatology 26:2, 274-277
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Christopher A.K.Y. Chong, George Tomlinson, Lisa Chodirker, Nassi Figdor, Mark Uster, Gary Naglie, Murray D. Krahn. (2006) An unadjusted NNT was a moderately good predictor of health benefit. Journal of Clinical Epidemiology 59:3, 224-233
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2006. Ganciclovir. , 1480-1482.
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Atul Humar. (2005) Valganciclovir for cytomegalovirus prevention and treatment. Therapy 2:3, 333-341
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Karl Wilkins, Jacqueline C. Dolev, Ryan Turner, Philip E. LeBoit, Timothy G. Berger, Toby A. Maurer. (2005) Approach to the treatment of cutaneous malignancy in HIV-infected patients. Dermatologic Therapy 18:1, 77-86
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Arun Chakrabarty, Karl Beutner. (2004) Therapy of other viral infections: herpes to hepatitis. Dermatologic Therapy 17:6, 465-490
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Arun Chakrabarty, Katie R Pang, Jashin J Wu, Julio Narvaez, Michael Rauser, David B Huang, Karl R Beutner, Stephen K Tyring. (2004) Emerging therapies for herpes viral infections (types 1 – 8). Expert Opinion on Emerging Drugs 9:2, 237-256
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Patrick Willemot, Marina B Klein. (2004) Prevention of HIV-associated opportunistic infections and diseases in the age of highly active antiretroviral therapy. Expert Review of Anti-infective Therapy 2:4, 521-532
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William G. Hodge, Jean-François Boivin, Stanley H. Shapiro, Richard G. Lalonde, Kirtida C. Shah, Bradley D. Murphy, Michel A. Dionne, Aashish Goela. (2004) Clinical risk factors for cytomegalovirus retinitis in patients with AIDS. Ophthalmology 111:7, 1326-1333
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Scott M Palmer, Dan C Grinnan, B Diane Reams, Mark P Steele, Robert H Messier, R Duane Davis. (2004) Delay of CMV infection in high-risk CMV mismatch lung transplant recipients due to prophylaxis with oral ganciclovir. Clinical Transplantation 18:2, 179-185
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Tamara R Vrabec. (2004) Posterior segment manifestations of HIV/AIDS. Survey of Ophthalmology 49:2, 131-157
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Raymund R Razonable, Carlos V Paya. (2004) Valganciclovir for the prevention and treatment of cytomegalovirus disease in immunocompromised hosts. Expert Review of Anti-infective Therapy 2:1, 27-41
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JAMES P. DUNN, MARK VAN NATTA, GREGORY FOSTER, BARUCH D. KUPPERMANN, DANIEL F. MARTIN, ALICE ZONG, DOUGLAS A. JABS. (2004) COMPLICATIONS OF GANCICLOVIR IMPLANT SURGERY IN PATIENTS WITH CYTOMEGALOVIRUS RETINITIS. RETINA 24:1, 41-50
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Giridhar S. Tirucherai, Ashim K. Mitra. (2003) Effect of hydroxypropyl beta cyclodextrin complexation on aqueous solubility, stability, and corneal permeation of acyl ester prodrugs of ganciclovir. AAPS PharmSciTech 4:3, 124-135
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Claire Pomeroy, Julie Ribes. 2003. Cytomegalovirus. .
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A. Erice, C. Tierney, M. Hirsch, A. M. Caliendo, A. Weinberg, M. A. Kendall, B. Polsky, . (2003) Cytomegalovirus (CMV) and Human Immunodeficiency Virus (HIV) Burden, CMV End-Organ Disease, and Survival in Subjects with Advanced HIV Infection (AIDS Clinical Trials Group Protocol 360). Clinical Infectious Diseases 37:4, 567-578
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Santo Landolfo, Marisa Gariglio, Giorgio Gribaudo, David Lembo. (2003) The human cytomegalovirus. Pharmacology & Therapeutics 98:3, 269-297
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MARIAN G. MICHAELS, DAVID P. GREENBERG, DIANE L. SABO, ELLEN R. WALD. (2003) Treatment of children with congenital cytomegalovirus infection with ganciclovir. The Pediatric Infectious Disease Journal 22:6, 504-508
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Y. Yazdanpanah, S. J. Goldie, A. D. Paltiel, E. Losina, L. Coudeville, M. C. Weinstein, Y. Gerard, A. D. Kimmel, H. Zhang, R. Salamon, Y. Mouton, K. A. Freedberg. (2003) Prevention of Human Immunodeficiency Virus–Related Opportunistic Infections in France: A Cost‐Effectiveness Analysis. Clinical Infectious Diseases 36:1, 86-96
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Thomas R. Fleming, Susan Ellenberg, David L. DeMets. (2002) Monitoring clinical trials: issues and controversies regarding confidentiality. Statistics in Medicine 21:19, 2843-2851
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Jacob Lalezari, Janette Lindley, Sharon Walmsley, Baruch Kuppermann, Martin Fisher, Dorothy Friedberg, Richard Lalonde, Sophie Matheron, Leopoldo Nieto, Francesca J. Torriani, Rod Van Syoc, Mary Ann Sutton, William Buhles, Mary Jean Stempien. (2002) A Safety Study of Oral Valganciclovir Maintenance Treatment of Cytomegalovirus Retinitis. JAIDS Journal of Acquired Immune Deficiency Syndromes 30:4, 392-400
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Rafael E de la Hoz, Gwen Stephens, Christopher Sherlock. (2002) Diagnosis and treatment approaches of CMV infections in adult patients. Journal of Clinical Virology 25, 1-12
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Rafik Samuel, Robert L. Bettiker, Byungse Suh. (2002) AIDS related opportunistic infections, going but not gone. Archives of Pharmacal Research 25:3, 215-228
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ADITYA ARORA, LAURI MAGEE, JUDITH PECK, JONATHAN SINGER. (2001) Antiviral therapeutics for the pediatric population. Pediatric Emergency Care 17:5, 369-380
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Pierre Reusser. (2001) Oral valganciclovir: a new option for treatment of cytomegalovirus infection and disease in immunocompromised hosts. Expert Opinion on Investigational Drugs 10:9, 1745-1753
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Asok Kurup, Francesca J. Torriani. (2001) Therapy and prevention of cytomegalovirus retinitis. Current Infectious Disease Reports 3:4, 371-377
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Michael F. Para, Leslie A. Kalish, Ann C. Collier, Richard B. Pollard, Princy N. Kumar, Letty Mintz, Frances R. Wallach, W. Lawrence Drew. (2001) Qualitative and Quantitative PCR Measures of Cytomegalovirus in Patients With Advanced HIV Infection Who Require Transfusions. Journal of Acquired Immune Deficiency Syndromes 26:4, 320-325
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Michael F. Para, Leslie A. Kalish, Ann C. Collier, Richard B. Pollard, Princy N. Kumar, Letty Mintz, Frances R. Wallach, W. Lawrence Drew. (2001) Qualitative and Quantitative PCR Measures of Cytomegalovirus in Patients With Advanced HIV Infection Who Require Transfusions. JAIDS Journal of Acquired Immune Deficiency Syndromes 26:4, 320-325
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A. E. Grulich, M. G. Law. (2001) Long-Term High-Dose Acyclovir and AIDS-Related Non-Hodgkins Lymphoma. Clinical Infectious Diseases 32:6, 989-990
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A. David Paltiel, S. J. Goldie, E. Losina, M. C. Weinstein, G. R. Seage, A. D. Kimmel, H. Zhang, K. A. Freedberg. (2001) Preevaluation of Clinical Trial Data: The Case of Preemptive Cytomegalovirus Therapy in Patients with Human Immunodeficiency Virus. Clinical Infectious Diseases 32:5, 783-793
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John H. Kempen, Kevin D. Frick, Douglas A. Jabs. (2001) Incremental Cost Effectiveness of Prophylaxis for Cytomegalovirus Disease in Patients with AIDS. PharmacoEconomics 19:12, 1199-1208
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Woraphot Tantisiriwat, William G. Powderly. (2000) PROPHYLAXIS OF OPPORTUNISTIC INFECTIONS. Infectious Disease Clinics of North America 14:4, 929-944
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Jeffrey L. Jones, Debra L. Hanson, Mark S. Dworkin, Harold W. Jaffe. (2000) Incidence and Trends in Kaposi's Sarcoma in the Era of Effective Antiretroviral Therapy. JAIDS Journal of Acquired Immune Deficiency Syndromes 24:3, 270-274
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Jeffrey L. Jones, Debra L. Hanson, Mark S. Dworkin, Harold W. Jaffe. (2000) Incidence and Trends in Kaposi's Sarcoma in the Era of Effective Antiretroviral Therapy. Journal of Acquired Immune Deficiency Syndromes 24:3, 270-274
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Wood, Alastair J.J., , Kovacs, Joseph A., Masur, Henry, . (2000) Prophylaxis against Opportunistic Infections in Patients with Human Immunodeficiency Virus Infection. New England Journal of Medicine 342:19, 1416-1429
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El-Sadr, Wafaa M., Burman, William J., Grant, Lisa Bjorling, Matts, John P., Hafner, Richard, Crane, Lawrence, Zeh, Doug, Gallagher, Barbara, Mannheimer, Sharon B., Martinez, Ana, Gordin, Fred, . (2000) Discontinuation of Prophylaxis against Mycobacterium avium Complex Disease in HIV-Infected Patients Who Have a Response to Antiretroviral Therapy. New England Journal of Medicine 342:15, 1085-1092
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Jonathan E. Kaplan, Henry Masur, King K. Holmes, Kenneth A. Freedberg, David Holtgrave, Stephen C. Piscitelli, Russell Van Dyke, Heather Watts. (2000) An Overview of the 1999 US Public Health Service/Infectious Diseases Society of America Guidelines for Preventing Opportunistic Infections in Human Immunodeficiency Virus–Infected Persons. Clinical Infectious Diseases 30:s1, S15-S28
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C. Piketty, C. Bardin, J. Gilquin, A. Gairard, F. Chast. (2000) Monitoring plasma levels of ganciclovir in AIDS patients receiving oral ganciclovir as maintenance therapy for CMV retinitis. Clinical Microbiology and Infection 6:3, 117-120
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W. Garrett Nichols, Michael Boeckh. (2000) Recent advances in the therapy and prevention of CMV infections. Journal of Clinical Virology 16:1, 25-40
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Vonda F Hoffman, Daniel J Skiest. (2000) Therapeutic developments in cytomegalovirus retinitis. Expert Opinion on Investigational Drugs 9:2, 207-220
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, . (2000) 1999 USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus. Infectious Diseases in Obstetrics and Gynecology 8:1, 3-74
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Brian S.N. Blank, Pieter L. Meenhorst, Gerrit Jan Weverling, Anneke A.M. Stout-Zonneveld, Wouter Pauw, Jan Willem Mulder, Willemien C. van Dijk, Paul Smits, Joep M.A. Lange. (1999) Quantitative pp65-antigenemia assay for the prediction of human cytomegalovirus disease in HIV-infected patients. AIDS 13:18, 2533-2539
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Michael R. Robinson, Michele L. Ross, Scott M. Whitcup. (1999) Ocular manifestations of HIV infection. Current Opinion in Opthalmology 10:6, 431-437
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M. Grzywacz, J.R. Deayton, E.F. Bowen, P. Wilson, V.C. Emery, M.A. Johnson, P.D. Griffiths. (1999) Response of asymptomatic cytomegalovirus viraemia to oral ganciclovir 3 g/day or 6 g/day in HIV-infected patients. Journal of Medical Virology 59:3, 323-328
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Martin J. Wiselka, Karl G. Nicholson, Stephen Rowley, Kim Bibby. (1999) Cytomegalovirus viraemia has poor predictive value for the development of cytomegalovirus disease in patients with advanced HIV-infection. Journal of Infection 39:3, 187-192
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Marc Jouan, Christine Katlama. (1999) Management of CMV retinitis in the era of highly active antiretroviral therapy. International Journal of Antimicrobial Agents 13:1, 1-7
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Jose L. Casado, Julio Arrizabalaga, Milagros Montes, Paloma Martí-Belda, Cristina Tural, Javier Pinilla, Carolina Gutierrez, Joseba Portu, Rob Schuurman. (1999) Incidence and risk factors for developing cytomegalovirus retinitis in HIV-infected patients receiving protease inhibitor therapy. AIDS 13:12, 1497-1502
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Caroline R Baumal, Alex V Levin, Stanley E Read. (1999) Cytomegalovirus retinitis in immunosuppressed children. American Journal of Ophthalmology 127:5, 550-558
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Daniel J. Skiest. (1999) Cytomegalovirus Retinitis in the Era of Highly Active Antiretroviral Therapy (HAART). The American Journal of the Medical Sciences 317:5, 318
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Whitley, Richard J., , Holland, Gary N., . (1999) Cytomegalovirus Retinitis — Evolving Therapies in a New Era. New England Journal of Medicine 340:14, 1108-1110
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Martin, Daniel F., Kuppermann, Baruch D., Wolitz, Richard A., Palestine, Alan G., Li, Hong, Robinson, Charles A., the Roche Ganciclovir Study Group. (1999) Oral Ganciclovir for Patients with Cytomegalovirus Retinitis Treated with a Ganciclovir Implant. New England Journal of Medicine 340:14, 1063-1070
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Gang Meng, Phillip D. Smith. (1999) Gastrointestinal infections in the immunocompromised host. Current Opinion in Gastroenterology 15:1, 85
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Stuart M. Flechner, Robin K. Avery, Rosemaree Fisher, Barbara A. Mastroianni, Doreen A. Papajcik, Kiaran J. O'Malley, Marlene Goormastic, David A. Goldfarb, Charles S. Modlin, Andrew C. Novick. (1998) A RANDOMIZED PROSPECTIVE CONTROLLED TRIAL OF ORAL ACYCLOVIR VERSUS ORAL GANCICLOVIR FOR CYTOMEGALOVIRUS PROPHYLAXIS IN HIGH-RISK KIDNEY TRANSPLANT RECIPIENTS1. Transplantation 66:12, 1682-1688
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MATHIEU ROBAIN, NICOLAS CARRÉ, ELISABETH DUSSAIX, DOMINIQUE SALMON-CERON, LAURENCE MEYER. (1998) Incidence and Sexual Risk Factors of Cytomegalovirus Seroconversion in HIV-Infected Subjects. Sexually Transmitted Diseases 25:9, 476-480
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Menno D. de Jong, George J. Galasso, Brian Gazzard, Paul D. Griffiths, Douglas A. Jabs, Earl R. Kern, Stephen A. Spector. (1998) Summary of the II International Symposium on Cytomegalovirus. Antiviral Research 39:3, 141-162
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David C Ritterband, Dorothy N. Friedberg. (1998) Virus infections of the eye. Reviews in Medical Virology 8:4, 187-201
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Mark D. Pescovitz, Timothy L. Pruett, Thomas Gonwa, Bonnie Brook, R. McGory, K. Wicker, Kay Griffy, Charles A. Robinson, Donald Jung. (1998) ORAL GANCICLOVIR DOSING IN TRANSPLANT RECIPIENTS AND DIALYSIS PATIENTS BASED ON RENAL FUNCTION1. Transplantation 66:8, 1104-1107
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John Gambertoglio, Princy Kumar, Douglas Dieterich, Mark A. Jacobson. (1998) Absence of Effect of Glutamic Acid Hydrochloride on the Bioavailability of Oral Ganciclovir in AIDS Patients With Cytomegalovirus Disease. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 18:4, 394-396
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Anita I Miedziak, Christopher J Rapuano, Stephen Goldman. (1998) Corneal endothelial precipitates in HIV- and CMV- positive patients without concomitant ocular disease. Eye 12:4, 743-745
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Frank D. Verbraak, Marcel Bruinenberg, Gerardus J. van den Horn, Christina Meenken, Allegonda van der Lelij, Carel B. Hoyng, Aize Kijlstra, Ron Peek. (1998) Cytomegalovirus (CMV) strain differences between the eye and blood in AIDS patients with CMV retinitis. AIDS 12:7, 713-718
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IBRAHIM TASKINTUNA, FIRAS M. RAHHAL, EDMUND V. CAPPARELLI, KENNETH C. CUNDY, WILLIAM R. FREEMAN. (1998) Intravitreal and Plasma Cidofovir Concentrations After Intravitreal and Intravenous Administration in AIDS Patients with Cytomegalovirus Retinitis. Journal of Ocular Pharmacology and Therapeutics 14:2, 147-151
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Joon H. Hong, Yongseok Choi, Byoung K. Chun, Kyeong Lee, Chung K. Chu. (1998) Current status of anti-HBV chemotherapy. Archives of Pharmacal Research 21:2, 89-105
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Richard W. Goodgame. (1998) HOW TO TREAT THE CYTOMEGALOVIRUS TROLL. The American Journal of Gastroenterology 93:3, 293-295
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Carol L. Brosgart, Thomas A. Louis, David W. Hillman, Charles P. Craig, Beverly Alston, Evelyn Fisher, Donald I. Abrams, Roberta L. Luskin-Hawk, James H. Sampson, Douglas J. Ward, Melanie A. Thompson, Ramon A. Torres. (1998) A randomized, placebo-controlled trial of the safety and efficacy of oral ganciclovir for prophylaxis of cytomegalovirus disease in HIV-infected individuals. AIDS 12:3, 269-277
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M.D de Jong, C.A.B Boucher, S.A Danner, B Gazzard, P.D Griffiths, C Katlama, J.M.A Lange, D.D Richman, S Vella. (1998) Summary of the international consensus symposium on management of HIV, CMV and hepatitis virus infections. Antiviral Research 37:1, 1-16
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Edward Gane, Faouzi Saliba, Garcia JC Valdecasas, John O'Grady, Mark D Pescovitz, Susan Lyman, Charles A Robinson. (1997) Randomised trial of efficacy and safety of oral ganciclovir in the prevention of cytomegalovirus disease in liver-transplant recipients. The Lancet 350:9093, 1729-1733
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David V. Ives. (1997) Cytomegalovirus disease in AIDS. AIDS 11:15, 1791-1797
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M. Scholz, J. Cinatl, H. W. Doerr. (1997) Prophylaxis of cytomegalovirus disease in high-risk patients. Infection 25:5, 269-273
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Daniela Francisci, Andrea Tosti, Franco Baldelli, Giuliano Stagni, Sergio Pauluzzi. (1997) The pp65 antigenaemia test as a predictor of cytomegalovirus-induced end-organ disease in patients with AIDS. AIDS 11:11, 1341-1345
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Jamal Temsamani, Gregory S Pari, Philippe Guinot. (1997) Antisense approach for the treatment of cytomegalovirus infection. Expert Opinion on Investigational Drugs 6:9, 1157-1167
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Richard D. Moore, Richard E. Chaisson. (1997) Cost-Utility Analysis of Prophylactic Treatment With Oral Ganciclovir for Cytomegalovirus Retinitis. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 16:1, 15-21
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Gregory J. Dore, Jennifer F. Hoy, Simon A. Mallal, Yueming Li, Anne M. Mijch, Martyn A. French, David A. Cooper, John M. Kaldor. (1997) Trends in Incidence of AIDS Illnesses in Australia From 1983 to 1994: The Australian AIDS Cohort. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 16:1, 39-43
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David N. Rose, Henry S. Sacks. (1997) Cost-effectiveness of cytomegalovirus (CMV) disease prevention in patients with AIDS. AIDS 11:7, 883-887
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Winston Cavert. (1997) VIRAL INFECTIONS IN HUMAN IMMUNODEFICIENCY VIRUS DISEASE. Medical Clinics of North America 81:2, 411-426
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Antonella dʼArminio Monforte, Franco Mainini, Letizia Testa, Luca Vago, Livia Balotta, Manuela Nebuloni, Spinello Antinori, Teresa Bini, Mauro Moroni. (1997) Predictors of cytomegalovirus disease, natural history and autopsy findings in a cohort of patients with AIDS. AIDS 11:4, 517-524
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Karen Kaae Dodt, Palle Høy Jacobsen, Bo Hofmann, Christian Meyer, Hans J. Kolmos, Peter Skinhøj, Bodil Norrild, Lars Mathiesen. (1997) Development of cytomegalovirus (CMV) disease may be predicted in HIV-infected patients by CMV polymerase chain reaction and the antigenemia test. AIDS 11:3, F21-F28
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Dorothy Nahm Friedberg. (1997) Cytomegalovirus Retinitis. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 14, S1-S6
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Stephen A. Spector. (1997) Current Therapeutic Challenges in the Treatment of Cytomegalovirus Retinitis. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 14, S32-S36
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Jacob P. Lalezari. (1997) Cidofovir. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 14, S22-S26
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D. Podzamczer, E. Ferrer, A. García, J. M. Ramón, J. Niubó, M. Santín, G. Rufí, J. L. Pérez, R. Martín, F. Gudiol. (1997) pp65 Antigenemia as a Marker of Future CMV Disease and Mortality in HIV-infected Patients. Scandinavian Journal of Infectious Diseases 29:3, 223-227
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Jan T.M. van der Meer, W.Lawrence Drew, Raleigh A. Bowden, George J. Galasso, Paul D. Griffiths, Douglas A. Jabs, Christine Katlama, Stephen A. Spector, Richard J. Whitley. (1996) Summary of the international consensus symposium on advances in the diagnosis, treatment and prophylaxis of cytomegalovirus infection. Antiviral Research 32:3, 119-140
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(1996) Oral Ganciclovir as Prophylaxis against Cytomegalovirus. New England Journal of Medicine 335:18, 1395-1397
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Antonio Volpi, Giuseppe Gentile. (1996) Future directions on prophylaxis and therapy of cytomegalovirus diseases. International Journal of Antimicrobial Agents 7:4, 287-291
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Henry H. Balfour. (1996) Prevention of cytomegalovirus disease. International Journal of Antimicrobial Agents 7:4, 283-285
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Wood, Alastair J.J., , Crumpacker, Clyde S., . (1996) Ganciclovir. New England Journal of Medicine 335:10, 721-729
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