NEW Source, Issue 8, April 1992 Page: 3
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NEWS rce
April 1992CMV: One tough cookie
by Matt EarnestSome Opportunistic In-
fections (Ols) can be extremely
stubborn. Cytomegalovirus
(CMV) has a long history in AIDS
research, and many believe that it
is actually a co-factor in AIDS.
That is, it has the dreaded ability
to hasten the onset of AIDS in
those who are HIV-positive.
A member of the beloved
Human Herpes Virus (HHV)
family, CMV enters the system
directly through contact with
mucous membranes or through
blood or tissue transfusion. CMV
is, in fact, indistinguishable by
negative staining electron mi-
croscopy from other herpes
viruses.3 Its symptoms include:
fever, aching, mild sore throat,
fatigue, and enlarged lymph
glands. In AIDS, CMV can wreak
further havoc and cause hepatitis,
retinitis (inflammation of the
retina), or colitis (inflammation of
the colon and/or intestinal
tract).2
A study, documented in
the New England Journal of
Medicine (Volume 326, number 4)
showed that of the two known
treatments for CMV -- foscarnet
and ganciclovir (or DHPG) -
foscarnet is more effective,
though not as well tolerated. The
study reported 65 deaths in the
ganciclovir group and only 36 in
the foscarnet group. Incidentally,
both ganciclovir and foscarnet
have been approved by the FDA
for CMV retinitis.
Many PWAs have em-
ployed the Hickman catheter for
CMV treatment. It is a tube in-
serted directly into a large vein
(usually the superior vena cava -
which leads directly to the right
atrium of the heart), and it allows
for immediate and thorough dis-
tributions of medicines.2
The catheter has done
wonders for many CMV (andMAI/MAC) patients. They need
not ever leave the doctor's office
again with their arms looking like
raw hamburger from hours of
trying to find a good vein for in-
jection. The only drawbacks
seem to be: 1) the nowadays ob-
solete chance of infection around
the catheter area, and 2) the psy-
chological difficulty of having
tubing running out of your chest;
but many agree that after one be-
comes accustomed to the
catheter, these hindrances are a
small price to pay for all of the
benefits.
So where does this leave
us? The foscarnet/ganciclovir
...the evidence
points to a prescrnp-
tion for fosarnet s
the best option.
trial stated that most of the peo-
ple in the foscarnet group had
partial vision restoration - as
long as they could tolerate the
renal (kidney) toxicity. Although
ganciclovir had strong results in
several of the subjects, the evi-
dence points to a prescription for
foscarnet as the best option.
Epidemiology
CMV infection is appar-
ently endemic worldwide, its
highest rates being among very
young children living in crowded
conditions. CMV can be congen-
ital, but is usually acquired.
The prevalence of viral
excretion in the urine, an indica-
tion of active infection, varies
from 0.5 to 2.0 percent at birth to
10 to 56 percent at six months of
age, depending upon a given
population.3 CMV is also ex-
creted inr feces, perspiration,saliva, and semen.2 PWAs, or
anyone else who has acquired
CMV, can excrete virus titers as
high as 106 infective units/mL in
the urine and/or saliva for sev-
eral months. This can also occur
in those who have been rein-
fected with a different strain of
CMV, or whose latent CMV has
reactivated.3
Considering the fre-
quency of retinitis among PWAs,
it is interesting to note that the
primary site of CMV infection in
immune suppressed persons is
the lungs.3 This accounts for all
patients undergoing immune
suppressive therapies (such as
chemotherapy) as well, which
brings the number of PWAs to a
much smaller one - relative to
the whole. A viral culture is now
necessary to diagnose CMV, a
measure intended to prevent the
high number of post mortem diag-
noses that went unnoticed while
the subject was living.
CMV has caused us lots
of grief, but thankfully, it is not
being ignored by scientists and
physicians. Their much wel-
comed studies continue to stim-
ulate thought, action, and
progress.
References:
1. Abrams, Dr. Donald I., et al; AIDS/HIV
Treatment Directory; American Foundation
for Aids Research (AmFAR); Volume 4,
number 3.
2. Callen, Michael, et al; Surviving and
Thriving With AIDS: Collected Wisdom,
Volume 2, pp 105-10.
3. Henry, Dr. John Bernard; Clinical
Diagnosis and Management, 18th edition,
pp 1230-3.
4. Lewis, R.A., et al; Mortality in Patients
with the Acquired Immunodeficiency
Syndrome Treated with either Foscarnet
or Ganciclovir for Cytomealovirus
Retinitis; New England Journal of Medicine,
Volume 326, no. 4, pp 213-20.3
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Dallas Buyer's Club. NEW Source, Issue 8, April 1992, periodical, April 1992; Dallas, Texas. (https://texashistory.unt.edu/ark:/67531/metadc271485/m1/3/: accessed June 2, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting UNT Libraries Special Collections.