TY - JOUR
T1 - Use of the ganciclovir implant for the treatment of cytomegalovirus retinitis in the era of potent antiretroviral therapy
T2 - Recommendations of the international AIDS society-USA panel
AU - Martin, Daniel F.
AU - Dunn, James P.
AU - Davis, Janet L.
AU - Duker, Jay S.
AU - Engstrom, Robert E.
AU - Friedberg, Dorothy N.
AU - Jaffe, Glenn J.
AU - Kuppermann, Baruch D.
AU - Polis, Michael A.
AU - Whitley, Richard J.
AU - Wolitz, Richard A.
AU - Benson, Constance A.
N1 - Funding Information:
● PURPOSE: To describe the risks, benefits, and recom-immunodeficiency virus disease has changed the manifes-mended use of the ganciclovir implant for the treatment tation and course of CMV retinitis in many patients. The of human immunodeficiency virus–related cytomegalovi-clinical management of CMV retinitis and the role of the rus (CMV) retinitis in the era of potent antiretroviral ganciclovir implant are thus changing. Factors in the therapy. decision to choose the ganciclovir implant include the ● METHODS: A panel of physicians with expertise in the patient’s potential for immunologic improvement, loca-use of the ganciclovir implant and in the management of tion and severity of CMV retinitis, and the risks and CMV retinitis was convened by the International AIDS costs associated with implantation and concomitant oral Society–USA. The panel reviewed and discussed avail-ganciclovir therapy. able data, and developed recommendations for the use of ● CONCLUSIONS: The ganciclovir implant is safe and the ganciclovir implant, the surgical technique, and related effective for the treatment of CMV retinitis. The indi-management issues. Recommendations were rated accord-cations for its use should be modified to account for ing to the strength and quality of the supporting evidence. increased patient survival and the potential for CMV ● RESULTS: The effect of potent antiretroviral therapy retinitis to be controlled by effective antiretroviral on the immunologic status of patients with human therapy. Optimal use of the ganciclovir implant and AcceptedforpublicationNov2,1998. discontinuation of therapy in selected patients with FromtheDepartmentofOphthalmology,EmoryUniversity,Atlanta, improvement in immunity may result in better long-term Georgia(DrMartin);theDepartmentofOphthalmology,JohnsHopkins visual outcomes. (Am J Ophthalmol 1999;127: thalmology,UniversityofMiami,Miami,Florida(DrDavis);theDepart-University,Baltimore,Maryland(DrDunn);theDepartmentofOph- 329 –339. © 1999 by Elsevier Science Inc. All rights ment of Ophthalmology, New England Medical Center, Boston, reserved.) Massachusetts (Dr Duker); the Department of Ophthalmology, Univer- sity of California at Los Angeles, Los Angeles, California (Dr Engstrom); the Department of Ophthalmology, New York University Medical CYTOMEGALOVIRUS(CMV)RETINITISISTHELEAD- Center, New York, New York (Dr Friedberg); the Department of ing cause of vision loss in patients with acquired Ophthalmology,DukeUniversity,Durham,NorthCarolina(DrJaffe); immunodeficiency syndrome (AIDS).1–3 Ganciclo-Irvine,California(DrKuppermann);NationalInstituteofAllergyandtheDepartmentofOphthalmology,UniversityofCaliforniaatIrvine, vir, foscarnet, and cidofovir are the most commonly used Infectious Disease, Bethesda, Maryland (Dr Polis); the Department of Pediatrics, University of Alabama, Birmingham, Alabama (Dr Whitley); the Department of Ophthalmology, Kaiser Permanente, San Francisco, California (Dr Wolitz); and the Department of Medicine, University of Colorado, Denver, Colorado (Dr Benson). Supported by the International AIDS Society–USA. Reprint requests to James P. Dunn, MD, or Daniel F. Martin, MD, International AIDS Society–USA, 1001 B O’Reilly Ave, PO Box 29916, San Francisco, CA 94129-0916; fax: (415) 561-6740; e-mail: info@iasusa.org
PY - 1999/3
Y1 - 1999/3
N2 - PURPOSE: To describe the risks, benefits, and recommended use of the ganciclovir implant for the treatment of human immunodeficiency virus- related cytomegalovirus (CMV) retinitis in the era of potent antiretroviral therapy. METHODS: A panel of physicians with expertise in the use of the ganciclovir implant and in the management of CMV retinitis was convened by the International AIDS Society-USA. The panel reviewed and discussed available data, and developed recommendations for the use of the ganciclovir implant, the surgical technique, and related management issues. Recommendations were rated according to the strength and quality of the supporting evidence. RESULTS: The effect of potent antiretroviral therapy on the immunologic status of patients with human immunodeficiency virus disease has changed the manifestation and course of CMV retinitis in many patients. The clinical management of CMV retinitis and the role of the ganciclovir implant are thus changing. Factors in the decision to choose the ganciclovir implant include the patient's potential for immunologic improvement, location and severity of CMV retinitis, and the risks and costs associated with implantation and concomitant oral ganciclovir therapy. CONCLUSIONS: The ganciclovir implant is safe and effective for the treatment of CMV retinitis. The indications for its use should be modified to account for increased patient survival and the potential for CMV retinitis to be controlled by effective antiretroviral therapy. Optimal use of the ganciclovir implant and discontinuation of therapy in selected patients with improvement in immunity may result in better long-term visual outcomes.
AB - PURPOSE: To describe the risks, benefits, and recommended use of the ganciclovir implant for the treatment of human immunodeficiency virus- related cytomegalovirus (CMV) retinitis in the era of potent antiretroviral therapy. METHODS: A panel of physicians with expertise in the use of the ganciclovir implant and in the management of CMV retinitis was convened by the International AIDS Society-USA. The panel reviewed and discussed available data, and developed recommendations for the use of the ganciclovir implant, the surgical technique, and related management issues. Recommendations were rated according to the strength and quality of the supporting evidence. RESULTS: The effect of potent antiretroviral therapy on the immunologic status of patients with human immunodeficiency virus disease has changed the manifestation and course of CMV retinitis in many patients. The clinical management of CMV retinitis and the role of the ganciclovir implant are thus changing. Factors in the decision to choose the ganciclovir implant include the patient's potential for immunologic improvement, location and severity of CMV retinitis, and the risks and costs associated with implantation and concomitant oral ganciclovir therapy. CONCLUSIONS: The ganciclovir implant is safe and effective for the treatment of CMV retinitis. The indications for its use should be modified to account for increased patient survival and the potential for CMV retinitis to be controlled by effective antiretroviral therapy. Optimal use of the ganciclovir implant and discontinuation of therapy in selected patients with improvement in immunity may result in better long-term visual outcomes.
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U2 - 10.1016/S0002-9394(98)00441-3
DO - 10.1016/S0002-9394(98)00441-3
M3 - Comment/debate
C2 - 10088745
AN - SCOPUS:0033105523
SN - 0002-9394
VL - 127
SP - 329
EP - 339
JO - American Journal of Ophthalmology
JF - American Journal of Ophthalmology
IS - 3
ER -