The daily intravenous infusions that were once required to slow the progression of CMV retinitis exacted a heavy toll, both in dollars and in quality of life, and patients were justly apprehensive about beginning infusion therapy. Now, with the widespread adoption of multidrug antiretroviral therapy that includes an HIV protease inhibitor, the natural history of AIDS-related CMV disease has changed markedly. Since early 1996, when saquinavir and ritonavir became commercially available in the United States and Europe, the incidence of new cases of CMV retinitis has declined dramatically. Any HIV-infected patient with these symptoms should be evaluated by an ophthalmologist who is familiar with HIV infection and its sequelae. The standard treatments for CMV retinitis are ganciclovir and foscarnet.
Maintenance is with the same dose, once daily.
Neither drug offers an advantage in efficacy for treating CMV retinitis, but they have different side-effects profiles. Thrombocytopenia is another, less common, side effect of treatment with ganciclovir. Considerable laboratory and clinical research has been devoted to attempts to develop more efficacious, less toxic treatments for CMV infections. These efforts are beginning to pay off, although nothing close to an optimally safe and effective treatment has been achieved. This article will provide a brief synopsis of all of the currently available treatments for CMV retinitis, to help clinicians develop treatment strategies for affected patients.