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MANAGEMENT
OF OPPORTUNISTIC INFECTIONS
IN
HIV-POSITIV PATIENTS
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FACT
SHEETS
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Cytomegalovirus
(CMV)
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A Viral Infection
Causative organisms
Cytomegalovirus, a member of the herpes of viruses.
Symptoms of active infection
Retinitis
The clinical presentation of CMV retinitis is a funcation
of the location of retinal lesions. CMV retinitis is
painless, and the most common presenting symptom is
the appearance of "floaters" that move across
the visual field.
Gastrointestinal disease
Oesophagitis and colitis are the most common manifestations
of CMV GI disease. oesophagitis presents with odynophagia
or substernal pain whereas colitis presents with diarrhoea,
often with some hematochezia and abdominal pain.
Neuroligic disease
The two most common neurologic syndromes caused by CMV
are polyradiculopathy and encephalitis. Both often occer
in patients already diagnosed with CMV retinitis o GI
disease.
Pneumonitis
CMV pneumonitis is a very rare complication of AIDS.
Diagnostic procedures
Retinitis
CMV retinitis is a clinical diagnosis that must be confirmed
by an experienced ophthalmologist who can verify the
presence of typical white opacified lesions, often with
associated hemorrhage.
Gastrointestinal disease
Diagnosis of CMV GI disease requires all three
of the following components:
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a.
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Presence of a cardinal symptom referable
to a specific part of the GI tract, such as odynophagia
for oesophagitis. |
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b.
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Gross macroscopic evidence of mucosal
erythema, erosion or ulceration. |
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c.
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Mucosal biopsy that confirms presence
of typical CMV cytopathology. |
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Neurologic disease
Diagnosis is based on typical clinical finding along
with either CSF polymorphonuclear pleocytosis for polyradiculopathy
or CT or MRI evidence for encephalitis.
Pneumonotis
Hypoxemia and interstitial infiltrates are present,
and a bronchoalveolar lavage or bronchoscopy biopsy
demonstrates typical CMV cytopathology.
Treatment
Systemic drugs for CMV disease
Ganciclovir
Standard inducation dose
of ganciclovir is 5 mg/kg q 12 hours for 2 to 3 weeks.
Doses must be adjusted for ranal funcation (consult
full prescribing information).
Maintenance therapy is
5.0 mg/kg/day. Doses must be adjusted for ranal funcation.
Alternatively, maintenance therapy can be used -l g
using the oral formulation. However, randomised trials
suggest that for retinitis, l.V. administration is more
effective.
Standard therapy for CMV retinitis
Induction therapy
Ganciclovir 5mg/kg l.V. b.i.d. for 14-21 days. Dose
should for creatinine clearance <70 ml/min.
Alternatively, cidofover l.V. mg/kg every 2 weeks.
Drug interactions
Didanosine
When ganciclovir and didanosine are co-administered
monitor for pancreatitis.
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