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Serious Cytomegalovirus Disease in the Acquired Immunodeficiency Syndrome (AIDS): Clinical Findings, Diagnosis, and Treatment

MARK A. JACOBSON, M.D.; and JOHN MILLS, M.D.
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▸Requests for reprints should be addressed to John Mills, M.D.; Ward 84, Building 80, San Francisco General Hospital, 995 Potrero, San Francisco, CA 94110.


San Francisco, California


© 1988 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1988;108(4):585-594. doi:10.7326/0003-4819-108-4-585
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Life-threatening opportunistic cytomegalovirus infection is a complication of the acquired immunodeficiency syndrome (AIDS) that occurs in 7.4% or more of patients with AIDS. Cytomegalovirus retinitis, colitis, esophagitis, and gastritis are the commonest manifestations of severe cytomegalovirus end-organ disease. Extensive trials with intravenous ganciclovir, a nucleoside analogue with myelosuppressive toxicity, have shown that ganciclovir halts the progression of cytomegalovirus retinitis and gastrointestinal disease. Since relapse is common when therapy is discontinued, most patients with AIDS need lifelong maintenance therapy. The clinical response to ganciclovir therapy is usually accompanied by diminished shedding of the virus. Based on limited data, foscarnet, a pyrophosphate analogue, also appears to have some efficacy in treating cytomegalovirus infection. Unlike ganciclovir, foscarnet does not cause myelosuppression. An important direction for future clinical research is the development of more effective and less toxic therapy, as well as orally bioavailable drugs for maintenance therapy.

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