Intravitreal Ganciclovir Effective Option for Treating Cytomegalovirus Retinitis in Resource-Limited Settings

January 04, 2012

By Will Boggs, MD

NEW YORK (Reuters Health) Jan 03 - Intravitreal ganciclovir is effective maintenance therapy for cytomegalovirus (CMV) retinitis in developing countries and other resource-limited settings, researchers from Singapore report online December 3 in Ophthalmology.

CMV retinitis is the most common opportunistic ocular infection in patients with AIDS, and it is the most common cause of visual loss in patients with HIV infection.

"In developing countries and places where patients are required to pay for medications, oral valganciclovir and ganciclovir implants -- now considered the 'gold standard' in developed countries -- are far too expensive or unavailable," Dr. Stephen C. Teoh from Tan Tock Seng Hospital in Singapore told Reuters Health by email.

"The 'traditional' intravitreal ganciclovir regimen used to treat CMV retinitis is still a very effective and economical way (to treat) local disease," he added.

Dr. Teoh and colleagues evaluated the efficacy and safety of an intermediate maintenance dose of intravitreal ganciclovir (1.0 mg/0.02 mL weekly after an induction regimen) in 34 eyes of 24 HAART-na�ve patients with CMV retinitis.

Patients received a median of 30 injections, and the patient with the longest follow-up received 220 injections in each eye over a 2.27 year period.

After treatment, visual acuity improved or remained stable in 22 eyes (64.7%) and worsened or progressed to no light perception in the remaining 12 eyes (35.3%).

Most patients (87.5%) showed clinical signs of complete resolution of CMV retinitis within the first four weeks, and there were no cases of drug failure with the treatment regimen.

Relapse followed treatment in 17 eyes of 10 patients, but the other 17 eyes remained stable and quiescent. Five of the 10 patients with relapses were receiving uninterrupted maintenance injections.

The cost per treatment was $30.00 per eye, resulting in a cost of approximately $1,800 for six months of bilateral treatment. The treatment cost for one eye is only 11.7% of the approximately $7,700 for a single sustained-release implant that lasts about six months.

"Although intravitreal ganciclovir treatment has been criticized as out-of-date by many developed countries, in settings where the economic and resource settings are not as fortunate or favorable, it remains a very good and viable option for patients who would have otherwise become blind," Dr. Teoh said. "We are in the process of a trial studying the optimal dosing interval with our intravitreal ganciclovir regimen."

He added that his team's regimen was adopted and started in Vietnam in 2009 under a joint program by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and Harvard Medical School AIDS Initiative in Vietnam (HAIVN).

"I understand various groups are also initiating intravitreal ganciclovir programs for similar indications around Southeast Asia, including Myanmar (California Pacific Medical Centre, USA) and Cambodia (Medicins sans Frontieres)," Dr. Teoh said.


Ophthalmology 2011.