| HIGHLIGHTS FROM IDSA
97 CMV in Patients
Treated with Protease Inhibitors
New data presented at the IDSA meeting showed that the use
of potent protease inhibitors as part of antiviral drug regimens affects the course of CMV
disease in HIV positive patients as measured in end-organ disease. A study by Mallolas et
al. in 42 patients (21 with cases and 21 controls) showed that in those 21 patients
who were on a PI-containing regimen, only two developed CMV retinitis, and those
developments occurred within two months of initiating PI therapy. Typically, all patients
who are CMV viral load-positive will have either initial progression or reactivation of
CMV retinitis within 4 and 30 weeks of reaching CD4 counts below 50 cells/mm3.
This study concludes that in HIV-infected patients treated
with protease inhibitors, CMV disease relapsed with lesser frequency than expected. CMV
may develop despite a high CD4 cell count, but disease progression typically occurred
shortly after starting PIs (when a rebound in CD4 cell count is often seen). The study
concluded that CMV prophylaxis (either primary or secondary) should not be withdrawn in
these patients despite achieving a rise in CD4 cell count above the safety threshold, at
least during the first months after starting PI therapy.
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