Mar 24, 2000
Please help!! What are the best treatments for CMS.
My CD4 level is very low!!
I an currently take Ganciclovir IV treatment and do
not want the Ganciclovir Eye Implants.
Thank You Very Much ...Email Address:
Response from Dr. Feinberg
The best treatment right now would be the implant to treat your eye disease, plus oral ganciclovir so that you do not develop CMV disease anywhere else besides the eye. If you really don't want an implant (why?), then you might do fine with just oral ganciclovir as long as your eye disease quiets down completely with IV treatment and your retinitis is not located right near a structure that is critical for vision, just in case the retinitis acts up again. Hopefully valganciclovir (which gets turned into ganciclovir in your body) will be available by prescription soon-- it's fewer pills and fewer doses per day, and gets higher blood levels of ganciclovir than the current oral ganciclovir provides. The alternatives are continued IV treatment with ganciclovir, foscarnet or cidofovir. The latter two can cause toxicity to the kidneys, so if you opt for IV therapy, IV ganciclovir would be the easiest choice.
Just as important as getting good treatment for your CMV is to get good combination treatment for your HIV. Some people with CMV retinitis have managed without continued drugs for CMV if their HIV viral load is suppressed and their CD4 cells increase as a result of therapy. So you should be thinking hard about that as well. Good luck.
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