The follow-up period for this trial was extremely short so it is impossible to say what will happen to the participants in the future. However, Dr. Griffiths expected that those who received six grams would also experience viral rebound some time after treatment terminated because CMV cannot be eradicated by present methods. Oral ganciclovir was well tolerated at both doses, but again, time on treatment was very short. Dr. Griffiths noted data from previous work by his London group indicating IV ganciclovir was more effective at clearing viremia than either dose of oral ganciclovir. The dose and the amount of time on oral ganciclovir are still unclear.
More trials are necessary to determine the best regimen.
The disadvantage of IV induction is, of course, the inconvenience and the possibility of introducing blood infections. If IV is not used, this preliminary study suggests that six grams may be more effective than three in clearing viremia. From the work Dr. Griffiths has done with transplant patients, he has seen that the presence of viremia in the blood identifies a risk for development of active disease in multiple organs. Dr. Griffiths tests all his patients with CD4 counts below 100 for the presence of CMV in the blood. If the results are negative, another test is performed at each subsequent visit.