valganciclovir and Acquired-Immunodeficiency-Syndrome

Topics: Acquired Immunodeficiency Syndrome; Adult; Antiviral Agents; Cytomegalovirus Infections; Drug Resistance, Viral; Ganciclovir; Humans; Male; Treatment Failure; Valganciclovir

Valganciclovir is an orally administered prodrug that is rapidly hydrolyzed to ganciclovir. We compared the effects of oral valganciclovir with those of intravenous ganciclovir as induction therapy for newly diagnosed cytomegalovirus retinitis in 160 patients with the acquired immunodeficiency syndrome (AIDS).. The primary end point was photographically determined progression of cytomegalovirus retinitis within four weeks after the initiation of treatment. Secondary end points included the achievement of a prospectively defined satisfactory response to induction therapy and the time to progression of cytomegalovirus retinitis. After four weeks, all patients received valganciclovir as maintenance therapy.. Eighty patients were randomly assigned to each treatment group. Of the patients who could be evaluated, 7 of 70 assigned to intravenous ganciclovir (10.0 percent) and 7 of 71 assigned to oral valganciclovir (9.9 percent) had progression of cytomegalovirus retinitis during the first four weeks (difference in proportions, 0.1 percentage point; 95 percent confidence interval, -9.7 to 10.0). Forty-seven of 61 patients (77.0 percent) assigned to intravenous ganciclovir and 46 of 64 (71.9 percent) assigned to valganciclovir had a satisfactory response to induction therapy (difference in proportions, 5.2 percentage points; 95 percent confidence interval, -20.4 to 10.1). The median times to progression of retinitis were 125 days in the group assigned to intravenous ganciclovir and 160 days in the group assigned to oral valganciclovir. The mean values for the area under the curve for the ganciclovir dosage interval were similar at both induction doses and maintenance doses. The frequency and severity of adverse events were similar in the two treatment groups.. Orally administered valganciclovir appears to be as effective as intravenous ganciclovir for induction treatment and is convenient and effective for the long-term management of cytomegalovirus retinitis in patients with AIDS.

Topics: Acquired Immunodeficiency Syndrome; Administration, Oral; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Retinitis; Disease Progression; Female; Ganciclovir; HIV; Humans; Injections, Intravenous; Male; Prodrugs; Valganciclovir; Viral Load

Topics: Acquired Immunodeficiency Syndrome; Anti-Bacterial Agents; Antiviral Agents; Ceftriaxone; Chlamydia trachomatis; Coinfection; Colonoscopy; Cytomegalovirus; DNA, Bacterial; Doxycycline; Drug Therapy, Combination; Granuloma; Humans; Intestinal Mucosa; Male; Middle Aged; Neisseria gonorrhoeae; Proctitis; Rectum; Sexually Transmitted Diseases; Treatment Outcome; Valganciclovir

This study reports the surgical outcomes of acquired immunodeficiency syndrome (AIDS) patients with Cytomegalovirus retinitis (CMVR) -related retinal detachments(RD) in an Asian population.. Review of CMVR characteristics, surgical outcomes and complications in 19 eyes with CMVR-related RD that underwent surgery from January 2000 to June 2011.. CMVR was inactive in 73.7% of the eyes at time of surgery. Anatomical success was achieved in 14 eyes. Seven eyes (36.8%) had improvement of two or more lines in visual acuity (VA) and 8 eyes (42.1%) maintained VA. Thirteen eyes presented with worse than 6/120 vision, with 30.8% of them achieving ambulatory vision or better. Five eyes had re-detachments. Median durations from CMVR and immune recovery uveitis (IRU) diagnoses to RD were 2.7 and 1.0 months respectively.. Surgery for CMVR-related RD is associated with good anatomical outcomes with most eyes maintaining or having improved vision. CMVR lesion size of <50% retinal area is associated with better outcomes. Eyes with CMVR and IRU require close monitoring for RD.

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Antiretroviral Therapy, Highly Active; Antiviral Agents; Asian People; CD4 Lymphocyte Count; Cytomegalovirus Retinitis; Endotamponade; Female; Ganciclovir; Humans; Laser Coagulation; Male; Middle Aged; Retinal Detachment; Scleral Buckling; Treatment Outcome; Valganciclovir; Visual Acuity; Vitrectomy

Immune reconstitution syndrome (IRS) is a complication caused by reactivation of the immune system that can occur after starting highly active antiretroviral therapy (HAART) in patients with acquired immunodeficiency syndrome (AIDS). Severe IRS associated with cytomegalovirus (CMV) in both eyes who had lost his left vision is reported.. A 37-year-old man with AIDS who had started HAART discontinued his medication. Two weeks after the re-induction of HAART, he suffered CMV retinitis OU. Vitreous opacity OU appeared 3 days later, and optic neuritis OS appeared 6 days after the onset; and visual acuity OS decreased to 0.06. As the number of CD 4 positive T lymphocytes (CD 4) increased from 39 to 118/microl in both the pre- and- post HAART, we diagnosed IRS and started anti- CMV and systemic steroid therapy and discontinued the HAART. The focus of CMV retinitis was improved; however, visual acuity OS did not improve.. Severe IRS with visual loss induced by CMV retinitis after HAART needs to be considered in low CD 4 level patients during the induction phase.

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Antiretroviral Therapy, Highly Active; Antiviral Agents; CD4 Lymphocyte Count; Cytomegalovirus Retinitis; Ganciclovir; Humans; Immune Reconstitution Inflammatory Syndrome; Male; Severity of Illness Index; Treatment Outcome; Valganciclovir; Visual Acuity

Topics: Acquired Immunodeficiency Syndrome; Africa South of the Sahara; AIDS-Related Opportunistic Infections; Anti-Retroviral Agents; Antiviral Agents; Asia, Southeastern; Blindness; CD4 Lymphocyte Count; Cytomegalovirus Retinitis; Developing Countries; Disease Outbreaks; Drug Costs; Ganciclovir; Health Services Accessibility; Humans; Mass Screening; Ophthalmoscopy; Program Development; Treatment Outcome; Valganciclovir

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cystitis; Cytomegalovirus Infections; Fatal Outcome; Ganciclovir; Hemorrhage; Humans; Lymphoma, AIDS-Related; Male; Valganciclovir

Valganciclovir is a prodrug of ganciclovir which has been developed for the treatment of cytomegalovirus (CMV) retinitis in patients with AIDS. Oral valganciclovir is rapidly absorbed and hydrolysed to ganciclovir. The oral bioavailability of ganciclovir after oral valganciclovir administration is high. Oral valganciclovir 900 mg provides a daily exposure of ganciclovir comparable to that of intravenous ganciclovir 5 mg/kg. A single, randomised, nonblind study indicated that oral valganciclovir (900mg twice daily for 3 weeks then 900 mg once daily) and intravenous ganciclovir (5 mg/kg twice daily for 3 weeks then 5 mg/kg once daily) were equally effective in the treatment of newly diagnosed CMV retinitis in 160 patients with AIDS. Valganciclovir appears to have a similar tolerability profile to intravenous ganciclovir during induction therapy in patients with AIDS and newly diagnosed CMV retinitis. During maintenance therapy with valganciclovir, the most commonly reported adverse events included neutropenia, anaemia, thrombocytopenia, gastrointestinal (including diarrhoea, nausea, vomiting and abdominal pain), fever, headache, insomnia, peripheral neuropathy, paraesthesia and retinal detachment.

Topics: Acquired Immunodeficiency Syndrome; Administration, Oral; Anemia; Antiviral Agents; Biological Availability; Cytomegalovirus Retinitis; Fever; Ganciclovir; Gastrointestinal Diseases; Headache; Humans; Infusions, Intravenous; Neutropenia; Paresthesia; Peripheral Nervous System Diseases; Prodrugs; Randomized Controlled Trials as Topic; Retinal Detachment; Sleep Initiation and Maintenance Disorders; Thrombocytopenia; Valganciclovir