Fact Sheet Number 501
- WHAT IS CMV?
- HOW IS CMV TREATED?
- CAN CMV BE PREVENTED?
- HOW DO I CHOOSE A TREATMENT FOR CMV?
- THE BOTTOM LINE
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PrintCytomegalovirus (CMV) is an opportunistic infection. About 50%
of the general population and 90% of people with HIV carry CMV.
A healthy immune system keeps this virus in check. When HIV
or another disease weakens immune defenses, CMV can attack several
parts of the body.
The most common illness caused by CMV is retinitis. This is
the death of cells in the retinas, the back of the eye. It can
quickly cause blindness unless treated. CMV can spread throughout
the body and infect several organs at once. The risk of CMV is
highest when CD4 cell counts
are below 100.
The first signs of CMV retinitis are vision problems such as
moving black spots. These are called “floaters.” They
may indicate an inflammation of the retina. Some doctors recommend
eye exams to catch CMV retinitis. The exams are done by an ophthalmologist
(an eye specialist.) If your CD4 count is below 200 and you experience
any vision problems, tell your doctor immediately.
The first treatments for CMV required daily intravenous infusions.
Either ganciclovir or foscarnet was used. These drugs can control
CMV disease, but can’t cure it. Because of the daily infusions,
most people had a permanent medication “port” inserted
into their chest or arm. These ports, called Hickman or Groschung
catheters, must be kept very clean to avoid infections. People
with CMV disease had to keep taking anti-CMV drugs for life.
CMV treatments have improved dramatically over the past several
years.
- 1995: A ganciclovir pill was approved to prevent CMV.
- 1995: Doctors used injections of ganciclovir and foscarnet
directly into the eye to stop retinitis.
- 1996: A ganciclovir implant was developed to release the
drug directly in the eye.
- 1996: Cidofovir was approved for intravenous use.
- 1996: A CMV viral load test was developed.
- 1998: Fomivirsen was approved for injection into the eye.
- 2001: Valganciclovir was approved. This is a new form of
ganciclovir that is stronger but with fewer pills.
Strong HIV medications can improve the immune system. Patients
can stop taking CMV drugs if their CD4 cell count goes over 100
to 150 and stays there for at least six months.
Ganciclovir was approved for prevention (prophylaxis) of CMV.
However, many physicians don’t prescribe it. They don’t want
to add up to 12 capsules a day for their patients. Also, it’s
not clear that it does any good. Two large studies came to different
conclusions. Finally, strong antiviral medications keep most
people’s CD4 counts high enough so that they won’t get CMV.
A TREATMENT FOR CMV?
There are several issues to consider when choosing a treatment
for active CMV disease:
How effective is it? Intravenous ganciclovir
appears to be the most effective overall CMV treatment. Implants
are very effective at stopping retinitis, but only in the eye
with the implant.
How is it administered? Pills are the easiest
to manage. Intravenous (IV) medication involves needle sticks
or implanting a medication line that might become infected. Ocular
injections mean inserting a needle directly into the eye. Implants,
which last six to eight months, take about an hour to insert in
an office procedure.
Is it a local therapy or systemic? Local therapies
affect just the eyes. CMV retinitis can progress rapidly and
lead to blindness. For this reason, it is treated aggressively
when it first shows up. The newer injections or implants put
medication directly into the eye and have the greatest impact
on retinitis.
CMV can also show up in other places in the body. To control
CMV in the rest of the body, you need a systemic (whole-body)
therapy. Intravenous medication can be used, or valganciclovir
pills.
What are the side effects? The intravenous CMV
drugs and valganciclovir can damage your bone marrow or kidneys.
This may require additional medications. Foscarnet involves
long, slow, daily infusions. Ganciclovir also requires daily
infusions. Cidofovir infusions are just once every two weeks
(after an initial weekly infusion period). This means you don’t
need an implanted medication line. However, cidofovir has some
serious side effects.
Strong anti-HIV drugs are probably the best way to prevent CMV.
If your T-cell count is below 200, talk with your doctor about
CMV prevention and a regular schedule of eye exams. If you experience
ANY unusual vision problems, see your doctor immediately!
Treatments directly in the eye make it possible to control
CMV retinitis. With the newer drugs to treat CMV, you can avoid
implanted medication lines and daily infusions.
Most people can safely stop taking CMV medication if their
T-cell counts go up and stay above 150 when they take anti-HIV
drugs.
Revised March 22, 2002
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