Treating HIV-associated cytomegalovirus retinitis with oral valganciclovir and intra-ocular ganciclovir by primary HIV clinicians in southern Myanmar: a retrospective analysis of routinely collected data.
AIDS-Related Opportunistic Infections
/ epidemiology
Administration, Oral
Adult
Antiviral Agents
/ administration & dosage
Cytomegalovirus
Cytomegalovirus Retinitis
/ drug therapy
Female
Ganciclovir
/ administration & dosage
HIV
Humans
Injections, Intraocular
Male
Middle Aged
Myanmar
/ epidemiology
Primary Health Care
Retrospective Studies
Treatment Outcome
Valganciclovir
/ administration & dosage
Visual Acuity
/ drug effects
Comorbidity
Cytomegalovirus
HIV/AIDS
Retinitis
South-East Asia
Valganciclovir
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
13 Nov 2020
13 Nov 2020
Historique:
received:
09
04
2020
accepted:
03
11
2020
entrez:
14
11
2020
pubmed:
15
11
2020
medline:
24
11
2020
Statut:
epublish
Résumé
Cytomegalovirus retinitis (CMVR) is an opportunistic infection in HIV-infected people. Intraocular or intravenous ganciclovir was gold standard for treatment; however, oral valganciclovir replaced this in high-income countries. Low- and middle-income countries (LMIC) frequently use intraocular injection of ganciclovir (IOG) alone because of cost. Retrospective review of all HIV-positive patients with CMVR from February 2013 to April 2017 at a Médecins Sans Frontièrs HIV clinic in Myanmar. Treatment was classified as local (IOG) or systemic (valganciclovir, or valganciclovir and IOG). The primary outcome was change in visual acuity (VA) post-treatment. Mortality was a secondary outcome. Fifty-three patients were included. Baseline VA was available for 103 (97%) patient eyes. Active CMVR was present in 72 (68%) eyes. Post-treatment, seven (13%) patients had improvement in VA, 30 (57%) had no change, and three (6%) deteriorated. Among patients receiving systemic therapy, four (12.5%) died, compared with five (24%) receiving local therapy (p = 0.19). Our results from the first introduction of valganciclovir for CMVR in LMIC show encouraging effectiveness and safety in patients with advanced HIV. We urge HIV programmes to include valganciclovir as an essential medicine, and to include CMVR screening and treatment in the package of advanced HIV care.
Sections du résumé
BACKGROUND
BACKGROUND
Cytomegalovirus retinitis (CMVR) is an opportunistic infection in HIV-infected people. Intraocular or intravenous ganciclovir was gold standard for treatment; however, oral valganciclovir replaced this in high-income countries. Low- and middle-income countries (LMIC) frequently use intraocular injection of ganciclovir (IOG) alone because of cost.
METHODS
METHODS
Retrospective review of all HIV-positive patients with CMVR from February 2013 to April 2017 at a Médecins Sans Frontièrs HIV clinic in Myanmar. Treatment was classified as local (IOG) or systemic (valganciclovir, or valganciclovir and IOG). The primary outcome was change in visual acuity (VA) post-treatment. Mortality was a secondary outcome.
RESULTS
RESULTS
Fifty-three patients were included. Baseline VA was available for 103 (97%) patient eyes. Active CMVR was present in 72 (68%) eyes. Post-treatment, seven (13%) patients had improvement in VA, 30 (57%) had no change, and three (6%) deteriorated. Among patients receiving systemic therapy, four (12.5%) died, compared with five (24%) receiving local therapy (p = 0.19).
CONCLUSIONS
CONCLUSIONS
Our results from the first introduction of valganciclovir for CMVR in LMIC show encouraging effectiveness and safety in patients with advanced HIV. We urge HIV programmes to include valganciclovir as an essential medicine, and to include CMVR screening and treatment in the package of advanced HIV care.
Identifiants
pubmed: 33187478
doi: 10.1186/s12879-020-05579-2
pii: 10.1186/s12879-020-05579-2
pmc: PMC7666479
doi:
Substances chimiques
Antiviral Agents
0
Valganciclovir
GCU97FKN3R
Ganciclovir
P9G3CKZ4P5
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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