Treatment outcomes of reduced-dose intravitreal ganciclovir for acquired immunodeficiency syndrome patients with cytomegalovirus retinitis_Chinese Journal of Ocular Fundus Diseases

Authors：

 Liang Xuemei , Chen Shanping , Yin Guina

Nanning Aier Eye Hospital, Nanning 530003, China;

Corresponding?author：

Liang Xuemei, Email: lxmyanke@163.com

Keywords：

Acquired immunodeficiency syndrome/complications; Cytomegalovirus retinitis/drug therapy; Ganciclovir/therapeutic use; Treatment outcome

DOI：

10.3760/cma.j.cn511434-20190214-00048

Video：

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Objective To evaluate the efficacy and safety of reduced-dose intravitreal ganciclovir for the treatment of acquired immunodeficiency syndrome (AIDS) patients with cytomegalovirus retinitis (CMVR).Methods A prospective observational cohort study observed 15 AIDS patients (28 eyes) who suffered from CMVR onset between January 2016 and December 2018 at Nanning Aier Eye Hospital. Among this 28 eyes, BCVA of 6 eyes (21.4%) were between moving hand to counting finger, 15 eyes (53.6%) were between 0.02 to 0.1 and 7 eyes were better than 0.1 (25.0%). All eyes received intravitreal injection 0.1 ml of ganciclovir at 4 mg/ml (contain ganciclovir 0.4 mg). The induction regimen was twice weekly for 2 weeks and a maintenance period of the same dose weekly. The mean number of injections was 7.1±1.7 times. For hospitalized patients who had no contraindicated received a 14-day twice daily intravenous ganciclovir (IVG) 5.0 mg/kg·d until complete resolution of CMVR. All patients were divided into intravitreal ganciclovir (IVTG) group and IVTG+IVG group according to different treatment plans, which were 5 cases with 8 eyes and 10 cases with 20 eyes, respectively. The follow-up was more than 6 months. BCVA, complete resolution or stable of the lesion and complications were observed.Results Six months later, 20 eyes (71.4%) had a obvious reduced or disappeared of the anterior chamber and vitreous inflammation, and the retinal lesions became stable or complete resolution. 24 eyes showed improvements of BCVA and 4 eyes showed stable. 2 eyes (7.1%) presented with BCVA ≤ counting finger, 7 eyes (25.0%) were 0.02 - 0.1 and 19 eyes were ≥ 0.1 (67.9%). Compared with before treatment, the ratio of BCVA that less than or equal to counting finger and between 0.02 to 0.1 decreased (21.4% vs 7.1% and 53.6% vs 25.0%, respectively), but the ratio of BCVA better than 0.1 increased (25.0% vs 67.9%). When IVTG+IVG group was compared with IVTG group, the average time-to-resolution of CMVR were 83.2±25.2 and 85.3±24.4 days respectively. There was no significant difference in resolution times (Z=0.17, P=0.87). The ratio of retinal lesions became stable or complete resolution were 75.0% (15 eyes) and 62.5% (5 eyes), there was no evident difference in time-to-resolution between the two groups (F=0.42, P=0.51). No recurrence was seen during the follow-up period. In cases of unilateral CMVR, there were no patients with a second eye involvement during the follow-up period. No endophthalmitis, vitreous hemorrhage, retinal detachment were found in our study.Conclusion Reduced-dose intravitreal ganciclovir is a safe and effective treatment option for CMVR.

Citation： Liang Xuemei, Chen Shanping, Yin Guina. Treatment outcomes of reduced-dose intravitreal ganciclovir for acquired immunodeficiency syndrome patients with cytomegalovirus retinitis. Chinese Journal of Ocular Fundus Diseases, 2020, 36(4): 280-284. doi: 10.3760/cma.j.cn511434-20190214-00048 Copy

1.	董曉慶, 季建強, 王燕. 2012年南京市艾滋病篩查實驗室質量考評結果分析[J]. 中國醫學創新, 2013, 10(29): 99-100. DOI: 10.3969/j.issn.1674-4985.2013.29.048.Dong XQ, Ji JQ, Wang Y. Assessment of quality of HIV screening laboratory in Nanjing in 2012[J]. Medical Innovation of China, 2013, 10(29): 99-100. DOI: 10.3969/j.issn.1674-4985.2013.29.048.
2.	Jabs DA, van Natta ML, Holbrook JT, et al. Longitudinal study of the ocular complications of AIDS: 1. Ocular diagnoses at enrollment[J]. Ophthalmology, 2007, 114: 780-786. DOI: 10.1016/j.ophtha.2006.11.008.
3.	Whitley RJ, Jacobson MA, Friedberg DN, et al. Guidelines for the treatment of cytomegalovirus diseases in patients with AIDS in the era of potent antiretroviral therapy: recommendations of an international panel. International AIDS Society-USA[J]. Arch Intern Med, 1998, 158(9): 957-969. DOI: 10.1001/archinte.158.9.957.
4.	Stewart MW. Optimal management of cytomegalovirus retinitis in patients with AIDS[J]. Clin Ophthalmol, 2010, 4: 285-299. DOI: 10.2147/opth.s6700.
5.	Biron KK. Antiviral drugs for cytomegalovirus diseases[J]. Antiviral Res, 2006, 71(2-3): 154-163. DOI: 10.1016/j.antiviral.2006.05.002.
6.	Jabs DA, Ahuja A, van Natta M, et al. Comparison of treatment regimens for cytomegalovirus retinitis in patients with AIDS in the era of highly active antiretroviral therapy[J]. Ophthalmology, 2013, 120(6): 1262-1270. DOI: 10.1016/j.ophtha.2012.11.023.
7.	Arevalo JF, Garcia RA, Mendoza AJ. High-dose (5000-microg) intravitreal ganciclovir combined with highly active antiretroviral therapy for cytomegalovirus retinitis in HIV-infected patients in Venezuela[J]. Eur J Ophthalmol, 2005, 15(5): 610-618. DOI: 10.1177/112067210501500512.
8.	Cochereau-Massin I, Lehoang P, Lautier-Frau M, et al. Efficacy and tolerance of intravitreal ganciclovir in cytomegalovirus retinitis in acquired immune deficiency syndrome[J]. Ophthalmology, 1991, 98(9): 1348-1353. DOI: 10.1016/s0161-6420(91)32135-3.
9.	Yutthitham K, Ruamviboonsuk P. The high-dose, alternate-week intravitreal ganciclovir injections for cytomegalovirus retinitis in acquired immune deficiency syndrome patients on highly active antiretroviral therapy[J]. J Med Assoc Thai, 2005, 88 Suppl 9: S63-68.
10.	Choopong P, Tesavibul N, Rodanant N. Crystallization after intravitreal ganciclovir injection[J]. Clin Ophthalmol, 2010, 4: 709-711. DOI: 10.2147/opth.s10949.
11.	Hodge WG, Lalonde RG, Sampalis J, et al. Once-weekly intraocular injections of ganciclovir for maintenance therapy of cytomegalovirus retinitis: clinical and ocular outcome[J]. J Infect Dis, 1996, 174(2): 393-396. DOI: 10.1093/infdis/174.2.393.
12.	中華醫學會感染病學分會艾滋病學組. 艾滋病診療指南(第三版)[J]. 中華傳染病雜志, 2015, 33(10): 577-593. DOI: 10.3760/cma.j.issn.1000-6680.2015.10.001.AIDS Professional Group, Society of Infectious Diseases, Chinese Medical Association. Guidelines for diagnosis and treatment of HIV/AIDS (the third edition)[J]. Chin J Infect Dis, 2015, 33(10): 577-593. DOI: 10.3760/cma.j.issn.1000-6680.2015.10.001.
13.	Fan JJ, Tao Y, Hwang DK. Comparison of intravitreal ganciclovir monotherapy and combination with foscarnet as initial therapy for cytomegalovirus retinitis[J]. Int J Ophthalmol, 2018, 11(10): 1638-1642. DOI: 10.18240/ijo.2018.10.10.
14.	謝連永, 陳超, 孔文君, 等. 玻璃體腔注射更昔洛韋治療AIDS合并巨細胞病毒視網膜炎療效觀察[J]. 疑難病雜志, 2019, 18(7): 715-718. DOI: 10.3969/j.issn.1671-6450.2019.07.016.Xie LY, Chen C, Kong WJ, et al. Analysis of intravitreal ganciclovir injection in the treatment of AIDS complicated with cytomegalovirus retinitis[J]. Chin J Diffic and Compl Cas, 2019, 18(7): 715-718. DOI: 10.3969/j.issn.1671-6450.2019.07.016.
15.	Choopong P, Vivittaworn K, Konlakij D, et al. Treatment outcomes of reduced-dose intravitreal ganciclovir for cytomegalovirus retinitis[J]. BMC Infect Dis, 2016, 16: 164. DOI: 10.1186/s12879-016-1490-6.
16.	Young S, Morlet N, Besen G, et al. High-dose (2000-microgram) intravitreous ganciclovir in the treatment of cytomegalovirus retinitis[J]. Ophthalmology, 1998, 105(8): 1404-1410. DOI: 10.1016/s0161-6420(98)98020-4.
17.	Jeon S, Lee WK. Cytomegalovirus retinitis in a human immunodeficiency virus-negative cohort: long-term management and complications[J]. Ocul Immunol Inflamm, 2015, 23(5): 392-399. DOI: 10.3109/09273948.2014.985385.

1. 董曉慶, 季建強, 王燕. 2012年南京市艾滋病篩查實驗室質量考評結果分析[J]. 中國醫學創新, 2013, 10(29): 99-100. DOI: 10.3969/j.issn.1674-4985.2013.29.048.Dong XQ, Ji JQ, Wang Y. Assessment of quality of HIV screening laboratory in Nanjing in 2012[J]. Medical Innovation of China, 2013, 10(29): 99-100. DOI: 10.3969/j.issn.1674-4985.2013.29.048.
2. Jabs DA, van Natta ML, Holbrook JT, et al. Longitudinal study of the ocular complications of AIDS: 1. Ocular diagnoses at enrollment[J]. Ophthalmology, 2007, 114: 780-786. DOI: 10.1016/j.ophtha.2006.11.008.
3. Whitley RJ, Jacobson MA, Friedberg DN, et al. Guidelines for the treatment of cytomegalovirus diseases in patients with AIDS in the era of potent antiretroviral therapy: recommendations of an international panel. International AIDS Society-USA[J]. Arch Intern Med, 1998, 158(9): 957-969. DOI: 10.1001/archinte.158.9.957.
4. Stewart MW. Optimal management of cytomegalovirus retinitis in patients with AIDS[J]. Clin Ophthalmol, 2010, 4: 285-299. DOI: 10.2147/opth.s6700.
5. Biron KK. Antiviral drugs for cytomegalovirus diseases[J]. Antiviral Res, 2006, 71(2-3): 154-163. DOI: 10.1016/j.antiviral.2006.05.002.
6. Jabs DA, Ahuja A, van Natta M, et al. Comparison of treatment regimens for cytomegalovirus retinitis in patients with AIDS in the era of highly active antiretroviral therapy[J]. Ophthalmology, 2013, 120(6): 1262-1270. DOI: 10.1016/j.ophtha.2012.11.023.
7. Arevalo JF, Garcia RA, Mendoza AJ. High-dose (5000-microg) intravitreal ganciclovir combined with highly active antiretroviral therapy for cytomegalovirus retinitis in HIV-infected patients in Venezuela[J]. Eur J Ophthalmol, 2005, 15(5): 610-618. DOI: 10.1177/112067210501500512.
8. Cochereau-Massin I, Lehoang P, Lautier-Frau M, et al. Efficacy and tolerance of intravitreal ganciclovir in cytomegalovirus retinitis in acquired immune deficiency syndrome[J]. Ophthalmology, 1991, 98(9): 1348-1353. DOI: 10.1016/s0161-6420(91)32135-3.
9. Yutthitham K, Ruamviboonsuk P. The high-dose, alternate-week intravitreal ganciclovir injections for cytomegalovirus retinitis in acquired immune deficiency syndrome patients on highly active antiretroviral therapy[J]. J Med Assoc Thai, 2005, 88 Suppl 9: S63-68.
10. Choopong P, Tesavibul N, Rodanant N. Crystallization after intravitreal ganciclovir injection[J]. Clin Ophthalmol, 2010, 4: 709-711. DOI: 10.2147/opth.s10949.
11. Hodge WG, Lalonde RG, Sampalis J, et al. Once-weekly intraocular injections of ganciclovir for maintenance therapy of cytomegalovirus retinitis: clinical and ocular outcome[J]. J Infect Dis, 1996, 174(2): 393-396. DOI: 10.1093/infdis/174.2.393.
12. 中華醫學會感染病學分會艾滋病學組. 艾滋病診療指南(第三版)[J]. 中華傳染病雜志, 2015, 33(10): 577-593. DOI: 10.3760/cma.j.issn.1000-6680.2015.10.001.AIDS Professional Group, Society of Infectious Diseases, Chinese Medical Association. Guidelines for diagnosis and treatment of HIV/AIDS (the third edition)[J]. Chin J Infect Dis, 2015, 33(10): 577-593. DOI: 10.3760/cma.j.issn.1000-6680.2015.10.001.
13. Fan JJ, Tao Y, Hwang DK. Comparison of intravitreal ganciclovir monotherapy and combination with foscarnet as initial therapy for cytomegalovirus retinitis[J]. Int J Ophthalmol, 2018, 11(10): 1638-1642. DOI: 10.18240/ijo.2018.10.10.
14. 謝連永, 陳超, 孔文君, 等. 玻璃體腔注射更昔洛韋治療AIDS合并巨細胞病毒視網膜炎療效觀察[J]. 疑難病雜志, 2019, 18(7): 715-718. DOI: 10.3969/j.issn.1671-6450.2019.07.016.Xie LY, Chen C, Kong WJ, et al. Analysis of intravitreal ganciclovir injection in the treatment of AIDS complicated with cytomegalovirus retinitis[J]. Chin J Diffic and Compl Cas, 2019, 18(7): 715-718. DOI: 10.3969/j.issn.1671-6450.2019.07.016.
15. Choopong P, Vivittaworn K, Konlakij D, et al. Treatment outcomes of reduced-dose intravitreal ganciclovir for cytomegalovirus retinitis[J]. BMC Infect Dis, 2016, 16: 164. DOI: 10.1186/s12879-016-1490-6.
16. Young S, Morlet N, Besen G, et al. High-dose (2000-microgram) intravitreous ganciclovir in the treatment of cytomegalovirus retinitis[J]. Ophthalmology, 1998, 105(8): 1404-1410. DOI: 10.1016/s0161-6420(98)98020-4.
17. Jeon S, Lee WK. Cytomegalovirus retinitis in a human immunodeficiency virus-negative cohort: long-term management and complications[J]. Ocul Immunol Inflamm, 2015, 23(5): 392-399. DOI: 10.3109/09273948.2014.985385.

Chinese Journal of Ocular Fundus Diseases

Treatment outcomes of reduced-dose intravitreal ganciclovir for acquired immunodeficiency syndrome patients with cytomegalovirus retinitis

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