[Therapeutic alternative or 2d choice drug. Trisodium phosphonoformate in cytomegalovirus retinitis]

From 01. 01. 1988 to June 1990, a total of 275 patients with AIDS had been examined in our ophthalmological out-patient clinic. The clinical diagnosis of a cytomegalovirus (CMV) retinitis was recorded in 56 of these patients (= 20.1%). The initial therapy, as usual, took the form of infusions of the virustatic drug ganciclovir at an induction dose of 10 mg/kg body weight per day (3 weeks), with a maintenance dose of 3.5-5 mg/kg body weight per day (5 days per week) thereafter. During maintenance therapy recurrences were observed in 15 cases and herpes simplex retinitis in 3, with progressive retinal destruction. Therefore we began treatment with trisodium phosphonoformate (Foscavir) at a dosage of 60 mg/kg body weight per day (3 weeks), continuing with maintenance therapy at 90 mg/kg body weight per day (7 days a week). After the induction dose 14 patients showed subjective improvement and satisfactory cicatrization of the retinal lesions. We monitored the retina by a standardized method and 50 wide-angle retinal photographs. One case of acute retinal necrosis (ARN) did not show any response to foscavir therapy. Typical side-effects of therapy with trisodium phosphonoformate were seldom seen: adverse events included renal dysfunction, neutropoenia, and asymptomatic hypocalcaemia. We conclude that trisodium phosphonoformate is an effective and well-tolerated agent for the treatment and prevention of relapse of CMW retinitis and can be used as an alternative ganciclovir.