Use of the ganciclovir implant for the treatment of cytomegalovirus retinitis in the era of potent antiretroviral therapy

Recommendations of the international AIDS society-USA panel

Daniel F. Martin, James P. Dunn, Janet L. Davis, Jay S. Duker, Robert E. Engstrom, Dorothy N. Friedberg, Glenn J. Jaffe, Baruch D. Kuppermann, Michael A. Polis, Richard J. Whitley, Richard A. Wolitz, Constance A. Benson

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)329-339
Number of pages11
JournalAmerican Journal of Ophthalmology
Volume127
Issue number3
DOIs
StatePublished - Mar 1999

Fingerprint

Cytomegalovirus Retinitis
Ganciclovir
Acquired Immunodeficiency Syndrome
Therapeutics
HIV
Virus Diseases
Immunity
Physicians
Costs and Cost Analysis
Survival

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Use of the ganciclovir implant for the treatment of cytomegalovirus retinitis in the era of potent antiretroviral therapy : Recommendations of the international AIDS society-USA panel. / Martin, Daniel F.; Dunn, James P.; Davis, Janet L.; Duker, Jay S.; Engstrom, Robert E.; Friedberg, Dorothy N.; Jaffe, Glenn J.; Kuppermann, Baruch D.; Polis, Michael A.; Whitley, Richard J.; Wolitz, Richard A.; Benson, Constance A.

In: American Journal of Ophthalmology, Vol. 127, No. 3, 03.1999, p. 329-339.

Research output: Contribution to journalArticle

Martin, DF, Dunn, JP, Davis, JL, Duker, JS, Engstrom, RE, Friedberg, DN, Jaffe, GJ, Kuppermann, BD, Polis, MA, Whitley, RJ, Wolitz, RA & Benson, CA 1999, 'Use of the ganciclovir implant for the treatment of cytomegalovirus retinitis in the era of potent antiretroviral therapy: Recommendations of the international AIDS society-USA panel', American Journal of Ophthalmology, vol. 127, no. 3, pp. 329-339. https://doi.org/10.1016/S0002-9394(98)00441-3
Martin, Daniel F. ; Dunn, James P. ; Davis, Janet L. ; Duker, Jay S. ; Engstrom, Robert E. ; Friedberg, Dorothy N. ; Jaffe, Glenn J. ; Kuppermann, Baruch D. ; Polis, Michael A. ; Whitley, Richard J. ; Wolitz, Richard A. ; Benson, Constance A. / Use of the ganciclovir implant for the treatment of cytomegalovirus retinitis in the era of potent antiretroviral therapy : Recommendations of the international AIDS society-USA panel. In: American Journal of Ophthalmology. 1999 ; Vol. 127, No. 3. pp. 329-339.
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abstract = "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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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.

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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.

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