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Ganciclovir and foscarnet efficacy in AIDS-related CMV polyradiculopathy
H J Anders1, N Weiss, J R Bogner
1The Medical Policlinic, Ludwigs-Maximilian University, Munich, Germany.
Abstract:
Cytomegalovirus (CMV) polyradiculopathy is a rare complication of AIDS in which ascending motor weakness, sensory loss and urinary retention are associated with polymorphonuclear pleocytosis and positive CMV polymerase chain reaction in the cerebrospinal fluid (CSF). We describe three patients with this syndrome. One patient's paresis improved after ganciclovir therapy. Another patient deteriorated despite foscarnet treatment, but improved after ganciclovir was added. The third patient died from ascending paralysis despite ganciclovir-foscarnet combination. Reviewing the literature, we conclude that antiviral treatment reduced mortality from 100 to 22%. In patients with ascending paralysis treatment, failure may be caused by viral drug resistance, at least in some patients. Risk factors for treatment failure are preceding monotherapy for other CMV diseases or persistent CSF pleocytosis on serial CSF analysis. We suggest that these patients should therefore be treated with the alternative drug or a ganciclovir-foscarnet combination therapy.
Insights
Cytomegalovirus (CMV) polyradiculopathy in AIDS patients causes progressive paralysis. Antiviral therapy significantly reduces mortality, but drug resistance can cause treatment failure.
Area of Science:
- Neurology
- Infectious Diseases
- Virology
Background:
- Cytomegalovirus (CMV) polyradiculopathy is a rare but severe complication in advanced Acquired Immunodeficiency Syndrome (AIDS).
- This neurological syndrome presents with ascending motor weakness, sensory deficits, and autonomic dysfunction like urinary retention.
Observation:
- The study details three AIDS patients diagnosed with CMV polyradiculopathy.
- Clinical responses to antiviral treatments varied, with some patients improving on ganciclovir, while others showed limited benefit or deterioration with foscarnet alone.
Findings:
- Antiviral treatment for CMV polyradiculopathy has dramatically reduced mortality rates from 100% to 22%.
- Treatment failure may be linked to viral drug resistance, particularly after prior monotherapy or in cases of persistent cerebrospinal fluid (CSF) pleocytosis.
Implications:
- Combination therapy with ganciclovir and foscarnet, or switching to an alternative drug, is recommended for patients experiencing treatment failure.
- Identifying risk factors like prior monotherapy and persistent CSF inflammation is crucial for optimizing treatment strategies in CMV polyradiculopathy.