Valganciclovir: A Review of Its Use in the Management of AIDS-Related Cytomegalovirus Retinitis

ABSTRACT

Background: AIDS-related cytomegalovirus (CMV) retinitis is one of the most serious ocular complications in individuals with AIDS. It can progress to blindness, and in some cases, be accompanied by potentially fatal systemic disease.Antiviral compounds including Ganciclovir, Foscarnet and Cidofovir are routinely used in the treatment of CMV infection and disease. However, these agents have a poor oral bioavailability and have the inconvenience and expense of intravenous administration. Aim: The aim of the present study was to evaluate the safety and the effectiveness of oral Valganciclovir in the treatment of CMV retinitis in HIV- infected patients. Methods: A cohort of 12 CMV retinitis patients with HIV was treated with Valganciclovir at the Department of Ophthalmology, JNIMS during the period of Apr 2013 - Mar 2016. The therapy of Valganciclovir was continued until the CMV retinitis was completely inactive, two reports of CD4+ T lymphocyte counts six months apart was > 100 and the patient was on HAART therapy. The clinical profiles of these patients before and after the therapy were compared. Results: On an average the patients received oral Valganciclovir therapy for 9 months. Post- HAART and anti-CMV treatment, Ophthalmology report showed a 1-2 line improvement in Snellens eye chart reading in three patients while among the remaining nine patients, seven had no change in vision and in two patients the eyes went Phthisical and had no perception of light vision (NPL) at the time of last follow up. All the patients had increased CD4 cell counts and remained clinically stable over 8-24 months follow up period. Only minor adverse effects were seen with the treatment. Conclusion: Oral valganciclovir therapy is highly effective for the induction and maintenance of AIDS related CMV retinitis . It’s used significantly improves the quality of life for patients with this disease as it has eliminated the need for chronic intravenous therapy for people with CMV retinitis