Treatment options for cytomegalovirus in advanced HIV-related disease

Up to 40% of AIDS patients are affected by cytomegalovirus (CMV) end-organ disease. Most cases manifest in CMV retinitis, but gastro-intestinal and central nervous system infection can occur in some patients. Ganciclovir, foscarnet and cidofovir (HPMPC) are efficacious for the management of CMV disease, although clinical relapse has been problematic and multiple combination regimens are under clinical investigation. All AIDS patients with CMV retinitis must remain on maintenance therapy for life to prevent relapse. Antiviral treatment is tailored to the individual, taking into consideration the route of administration, adverse reactions, drug interactions, extent of disease, health-related quality-of-life and socioeconomic concerns.