Chart of opportunistic infections
October 2001 View PDF En
español
Cytomegalovirus (CMV)
Cytomegalovirus is a virus that infects the entire body.
Symptoms
(CMV-related) Retinitis (in eye, retina): blurry vision or loss
of central vision that can lead to blindness.
Colitis (colon): fevers, diarrhea and stomach pain.
Esophagitis (throat): ulcerations, pain and difficulty in swallowing.
Pneumonitis (lungs): pneumonia-like symptoms.
Encephalitis (brain): confusion, fever and tiredness.
Diagnosis
Retinitis: eye doctor (ophthalmology) exam.
Esophagitis and colitis: endoscopy and/or biopsy.
Pneumonitis: diagnose for other organisms first such as bacteria,
Pneumocystis carinii, etc. If negative, then bronchoscopy with bronchoalveolar
lavage and/or biopsy.
Encephalitis: Brain MRI (magnetic resonance imaging) and spinal
tap.
Preventive Therapy (prophylaxis)
People whose CD4+ cell counts are consistently below 50 and who
are CMV-positive are at highest risk for CMV disease and should
consider oral ganciclovir (1g three times a day).
Pregnant women should not take oral ganciclovir because of possible
birth defects. Also, women who become pregnant should stop using
oral ganciclovir.
Stopping Preventive Therapy
It may be reasonable to consider stopping CMV preventive therapy
for people with sustained CD4+ cell counts above 100–150 for
6 months or longer as a result of potent anti-HIV therapy.
Treatment
Retinitis preferred treatment: Ganciclovir implants + oral ganciclovir
(1,000mg three times a day); IV ganciclovir (5mg/kg every 12 hours
for 14–21 days); IV foscarnet (90mg/kg every 12 hours for
14–21 days); or oral valganciclovir (900mg twice a day for
21 days then 900mg once a day for 7 days).
Alternatives: IV cidofovir (5mg/kg once a week for 2 weeks) + probenecid
or combination IV ganciclovir + IV foscarnet (as dosed above).
Esophagitis and colitis: IV ganciclovir or IV foscarnet for 3–6
weeks.
Pneumonitis: IV ganciclovir or IV foscarnet for 3–6 weeks.
Encephalitis: IV ganciclovir, IV foscarnet or combination of both
until clinical improvement.
Maintenance Therapy
Retinitis preferred treatment: IV ganciclovir (5mg/kg once a day);
IV foscarnet (90–120mg/kg once a day); or ganciclovir implants
+ oral ganciclovir or oral valganciclovir (900mg once a day).
Alternatives: IV cidofovir (5mg/kg once every 2 weeks) or IV ganciclovir
+ IV foscarnet (as dosed above).
Esophagitis and colitis: Maintenance therapy is controversial although
it might be considered if the initial symptoms were severe.
Pneumonitis: Not recommended.
Encephalitis: IV ganciclovir, IV foscarnet or combination of the
two.
Pregnant women should take maintenance therapy, and the choice of
therapy should be individualized.
Stopping Maintenance Therapy
It may be reasonable for people with sustained CD4+ cell counts
above 100–150 (at least 3–6 months) and sustained suppression
of viral load to consider stopping CMV retinitis maintenance therapy.
Maintenance therapy should be restarted if CD4+ cell counts return
to 50–100.
For more information, read Project Inform’s publication,
Cytomegalovirus.
