Cytomegalovirus colitis and wasting

Article Abstract:

Wasting (emaciation) is commonly seen in patients with AIDS, which leaves the body vulnerable to many opportunistic infections, including those caused by cytomegalovirus (CMV). CMV colitis results in inflammation of the colon, and is associated with wasting. This review examines the association between CMV colitis and wasting, and assesses the effects of the antiviral drug ganciclovir on CMV and wasting. Research has shown that AIDS patients suffer from severe, progressive depletion of body cell mass due to severe protein depletion. The timing of death in these patients is closely related to that found in cases of starvation; consequently, the prevention of wasting in patients with AIDS is of extreme importance. Wasting in AIDS patients varies, indicating that it is probably related more to the effects of opportunistic infections rather than to AIDS itself. These infections usually interfere with intestinal absorption of nutrients. Twelve AIDS patients suffering from CMV infections, 10 of whom had CMV colitis, were evaluated. Eight of the CMV-infected patients were treated with ganciclovir. The four untreated patients showed continued wasting, while five of the eight treated patients gained weight. Two of the ganciclovir-treated patients who did not gain weight were found to have bacterial infections. The effects of ganciclovir treatment on the quality of life and length of survival of AIDS patients with CMV infections have not been completely studied. Clinical evidence indicates great improvements in quality of life with ganciclovir treatment, and indirect evidence indicates that length of survival is increased as well. Research strongly suggests that CMV infections can cause wasting in AIDS patients and that treatment with ganciclovir can reverse this wasting. In patients who do not respond to treatment, other infections should be suspected. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Causes of, Malnutrition, Colon (Anatomy), Colon, Colitis

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Clinical use of ganciclovir for cytomegalovirus infection and the development of drug resistance

Article Abstract:

Cytomegalovirus infection occurs in a large percentage of most healthy populations. In developed countries, half the population is usually infected by 50 years of age. Infection is usually asymptomatic and the virus usually remains dormant. However, the virus may become reactivated, particularly in immunocompromised persons such as those with AIDS. Most AIDS patients (90 percent) develop active CMV infection, which can cause retinitis (inflammation of the retina), colitis (inflammation of the colon), and other severe problems. The antiviral drug ganciclovir is used to treat CMV infections; it works by inhibiting viral DNA polymerase, which is necessary for viral replication. Ganciclovir is given intravenously, initially in high doses to stop viral replication quickly, then in lower doses for maintenance. Studies have shown it to be highly effective in inhibiting CMV replication and in treating CMV infections. Some patients have not responded to treatment with ganciclovir, and CMV strains resistant to the drug have been found. Studies on these strains of CMV have not revealed the precise mechanism by which resistance is gained, but it is thought that resistant strains have a decreased rate of phosphorylating the drug. This process is required for the drug to become active within the cell. A new drug known as foscarnet is also being used to treat CMV infections. Patients who do not respond to treatment with ganciclovir should be tested for resistant CMV strains, and be considered for treatment with foscarnet. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Drug resistance in microorganisms, Microbial drug resistance, Viruses, Cytomegaloviruses, Cytomegalovirus, Foscarnet

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