[Treatment of cytomegalovirus infections in HIV infection]

Cytomegalovirus (CMV) infections are common in patients with AIDS. Retinal localizations predominate, although digestive and neurological and more rarely pulmonary localizations are sometimes seen. Functional prognosis is poor in case of retinal infection requiring early treatment. Standard therapy is based on intravenous administration of two antiviral agents with similar actions: ganciclovir and foscarnet. Maintenance therapy, aimed at delaying recurrence, is clearly indicated for retinitis and may be so for other localizations. The parenteral route is recommended although in case of contraindications, oral ganciclovir and local treatments (intravitreal injections, intravireal implants) may be used. Recurrence is observed earlier after oral treatment, local treatments cannot prevent other localizations and retinal detachment is more frequent with vitreal implants. Other drugs are under study. Cygalovir would be an interesting alternative due to its long half-life allowing fewer injections. Primary prophylaxy for CMV infection is an important perspective. Quantitative PCR will help better define risk groups of patients who could benefit from preventive therapy. The choice between oral or intravenous administration and the correct dose remain to be determined for the most effective preventive treatment and to avoid the emergence of resistance.