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What are the signs and symptoms of cytomegalovirus?

May 8, 1996

"What are the signs and symptoms of cytomegalovirus?"

Response from Dr. Cohen

Cytomegalovirus (CMV) is a virus which most HIV-infected individuals have been exposed to, and which can reactivate and cause disease when you become immunosuppressed, almost always when your CD4 cell count has fallen below 50. The most common form of CMV disease is retinitis, or disease involving the back of the eye. If untreated it can lead to blindness. The symptoms depend on what part of the retina is affected. There may be no symptoms at all if the retinitis is peripheral (involving parts of the retina far from the optic nerve and macula). Retinitis in more central areas can lead to diminished vision or to "field cuts"--loss of sight in a particular segment of your visual field. Retinitis may also lead to "floaters," those strange little squiggly things that float across your field of vision. While everyone sees floaters from time to time, people with HIV infection and a low CD4 cell count should tell their doctor if they see them more frequently. Because retinitis is a rapidly progressive disease, and because symptoms tend to occur when the retinitis is present in a central location, you should always take visual symptoms seriously and have them evaluated quickly. CMV can also cause disease in the gastrointestinal tract. A symptom of esophagitis can be pain on swallowing, although this is more often caused by candida. Symptoms of gastritis (stomach disease) may be nausea, vomiting, and abdominal pain. Symptoms of enteritis or colitis (intestinal disease) may start with diarrhea, cramps, and abdominal pain. When CMV involves the brain (encephalitis) it usually seems very much like dementia except that it progresses more rapidly. Encephalitis tends to occur later, in people who already have CMV elsewhere. When CMV affects the spinal cord, it is called radiculopathy. The symptoms include pain or numbness in the back or buttocks, leg weakness, and sometimes loss of bowel or bladder control. CMV rarely affects the lungs, but when it does it can appear very much like PCP. CMV disease is a treatable condition. The treatment usually involves two weeks of high-dose intravenous ganciclovir or foscarnet, followed by life-long suppressive therapy, either with a lower dose of the same drug or with oral ganciclovir. Other treatments used for CMV retinitis include cidofovir, surgical implantation of a device that releases drug slowly into the eye, or periodic injections of drugs into the eye (with very tiny needles). I've discussed the prevention of CMV disease in my article on opportunistic infection prophylaxis that is posted at this site.

Cryptococcal / Cryptococcal Meningitis
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