Cytomegalovirus (CMV)

October 2007 View PDF En español

How do you treat CMV disease?

Most of the time, treating CMV disease happens in two stages: induction therapy and maintenance therapy. Induction therapy is used to treat the disease when it first appears and usually takes 2–3 weeks. Maintenance therapy is used to prevent the virus from causing disease again.

Treating CMV disease depends on the type of CMV disease (CMV retinitis, CMV colitis, or both, etc.) as well as how severe it is. People with CMV retinitis can take medicine by mouth, implants in the eye (ocular implants), injection or IV line. Because several of the drugs are given by IV, they may impose changes in a person’s lifestyle. Below is a list of the six medicines now available for treating CMV disease.

These medicines can interact with many drugs, including some anti-HIV drugs and common over-the-counter drugs like NSAIDs. A good way to learn about possible drug interactions is by reading the full package insert of your prescription or talking to your doctor or pharmacist.

Ganciclovir (Cytovene):
Ganciclovir can be used to treat all forms of CMV disease. Ganciclovir is given through an IV line (intravenously in the vein) and as a pill. For induction therapy, it’s given by IV (5mg per kg of body weight) twice a day for 2 to 3 weeks. For maintenance, it’s given either by IV once a day for 5–7 days a week or by 1,000mg capsules 3 times a day. Possible side effects include low red blood cells (anemia), low white blood cells, low platelets, nausea, vomiting, diarrhea, constipation, stomach pain, loss of appetite, dry mouth, mouth sores, trouble sleeping, nervousness, depression, sweating and joint or muscle pain.

Foscarnet (Foscavir):
Foscarnet can be used to treat all forms of CMV disease. Foscarnet is given through an IV line. For induction therapy, it’s given either 2 (90 mg per kg of body weight) or 3 times a day for 2 or 3 weeks. For maintenance, it’s given once a day. Possible side effects include kidney damage, low red blood cells (anemia), nausea, diarrhea, vomiting, fever, stomach pain, loss of appetite, confusion, dizziness and headache. Foscarnet should be stored in a refrigerator and out of direct light.

Neither ganciclovir or foscarnet offers an advantage over the other in treating CMV disease. However, the drugs have different side effects, and people often choose one over the other based on which side effects are of more concern to them. The major side effect of ganciclovir is low neutrophil counts (neutropenia). These cells are important for fighting bacterial infections. The major side effect of foscarnet is kidney toxicity. In studies, 16% (ganciclovir) and 20% (foscarnet) of people stopped the drug due to these side effects. So they roughly occur at the same rate, but one or the other may be of a greater concern for a person based on their health status or risk of side effects from taking other therapies.

As with the trend in prescribing anti-HIV drugs, more often doctors are combining different ways to treat CMV disease. This includes using combinations of both IV ganciclovir and foscarnet and/or combining IV therapy with medicine that’s taken orally or through ocular injection or implant.

Valganciclovir (Valcyte):
Valganciclovir is the only approved oral treatment and is as effective as IV ganciclovir for treating CMV retinitis. For induction therapy, it’s given as two 450mg tablets twice a day for 3 weeks. For maintenance, it’s given as two 450mg tablets once a day. Possible side effects include low red blood cells (anemia), low white blood cells, low platelets, diarrhea, upset stomach, vomiting, stomach pain, loss of appetite, thirst, fever, constipation, headache, back pain, leg swelling and trouble walking or sleeping.

The benefit of using oral therapy for the first time in treating CMV is that it does not cause neutropenia. It avoids the possible complications, such as sepsis, that accompany giving medicines through an IV.

Cidofovir (Vistide):
Cidofovir has been studied for CMV retinitis and may be effective for other forms of the disease. Cidofovir (5 mg per kg of body weight) is given through an IV line with probenecid (to help prevent kidney damage from the cidofovir). For induction therapy, it’s given once a week for 2 weeks. For maintenance, it’s given once every 2 weeks. Possible side effects include kidney damage, kidney failure and low white blood cells.

The benefit of cidofovir is that it only taken once a week, which greatly reduces the impact of twice a day IV therapy on daily life and routines. However, the increased risk of quite serious side effects, such as kidney damage, makes it less desirable to use. It is often used only when the other IV therapies no longer are suitable options due to resistance, failure or side effects.

Ganciclovir implant (Vitrasert):
This implant is only used for CMV retinitis and does not prevent CMV disease in other parts of the body, including the other eye. Ganciclovir implant is a pellet surgically implanted into the affected eye and changed every 6 months. For induction and maintenance therapy, it’s given either 2 or 3 times a day for 2 or 3 weeks. Possible side effects include loss of white blood cells as well as discomfort from surgery and some loss of clear vision, both of which are usually temporary. The implant is often used together with oral valganciclovir or ganciclovir.

Formivirsen (Vitravene):
Formivirsen is used to treat CMV retinitis for patients who have failed the other therapies listed. Formivirsen is given as a shot into the affected eye. For induction therapy, it’s given every other week for 2 doses. For maintenance, it’s given once every 4 weeks. Possible side effects include minor pain, redness or swelling of the eye.

Ocular implants and injections do not prevent CMV disease throughout the body. However, when used together with IV or oral medication, they can be very effective at treating the localized disease in the eye and may save a person’s eyesight.

Symptoms of disease

LAST NEXT