Promising new treatments for cytomegalovirus retinitis

Article Abstract:

A new maintenance treatment option for cytomegalovirus retinitis (CMV) approved by the FDA is oral ganciclovir. The dosage is 1000 mg three times a day in 12 tablets. CMV causes loss of vision and eventually, blindness. Oral ganciclovir also has the potential of being used as a prophylactic to reduce the development of retinitis, fevers, wasting diseases and colitis. Patients may have difficulty taking 12 tablets a day, and viral resistance can develop sooner than by using the intravenous form. The cost is $39 a day. Intraocular sustained-release ganciclovir implant can be used for chronic maintenance therapy and acute therapy. However, retinal attachments can develop with implants, and they do not offer whole body treatment. For example, there is a 50% chance that CMV retinitis will develop in the uninvolved eye at six months, because CMV is not just an eye disease but a demonstration of HIV infection.

Column, Cytomegalovirus infections

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Prophylactic Cesarean Delivery for the Prevention of Perinatal Human Immunodeficiency Virus Transmission: The Case For Restraint

Article Abstract:

It may not be necessary to give all HIV-infected pregnant women a cesarean to prevent them from transmitting the virus to their baby. Although studies have shown cesarean delivery to be effective for this purpose, most of the benefit occurred in women who had never taken any AIDS drugs. Now that combination therapy using protease inhibitors can lower viral levels to undetectable levels, many pregnant women may benefit from this therapy. An abdominal operation can have serious complications and women with advanced HIV infection are the most vulnerable to postoperative complications.

Health aspects, Pregnancy, Cesarean section, HIV infection in pregnancy

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An Asymptomatic 41-Year-Old Man With HIV Infection

Article Abstract:

There is no consensus on how to treat people with HIV infection who have no symptoms. The case of a 41-year-old gay man illustrates the difficulty. He has been HIV-positive for almost 10 years and even though he stopped his medication, his T-cell counts are stable and his viral load has remained low. He has no symptoms and questions whether he needs to take protease inhibitors. In these cases, it is appropriate to test patients every three months to detect any drop in their T-cell count. Treatment can be started if the count drops to 500 or less.

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