This is not the latest info but I thought it might be of interest:
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Protease inhibitors and CMV -- cause for concern (further reports from
Washington)
February 24, 1997
Doctors in several cities throughout the United States have recently
documented 5 cases of CMV retinitis occurring in patients using protease inhibitors who had at least 200 CD4+ cells at the time of diagnosis. CMV retinitis is a sight-threatening infection caused by a herpes-type virus called cytomegalovirus that is usually observed in HIV-infected people with fewer than 100 CD4+ cells. According to reports, the subjects in question had less than 85 CD4+ cells a month or two prior to diagnosis with CMV. They then began combination therapy including protease inhibitors, and in spite of a rise in CD4+ cells, retinitis developed.
Meanwhile, doctors in France have diagnosed at least 8 cases of active CMV infection among 210 patients within 10 weeks of starting combination anti-HIV therapy using protease inhibitors. The average CD4+ count of this group before therapy was 37 cells. Despite an increase in this figure to 185 cells, CMV flared up an average of 37 days after beginning therapy. Of the 8 subjects, 5 were using indinavir and 3, ritonavir.
Elsewhere in France, doctors have reported cases of herpes infections of the eye in patients shortly after starting combination therapy with protease inhibitors. One patient suffered VZV infection (varicella-zoster virus) of the eye 8 days after starting therapy. Another developed CMV retinitis within 9 days of beginning therapy. In 2 others, previously diagnosed retinitis became worse after initiating therapy with these same drugs.
As a possible explanation for these occurrences, French researchers offered the following:
* protease inhibitors may weaken the ability of CD8+ cells to control herpes infections
* protease inhibitors may stimulate the growth of herpes viruses
Until a concrete explanation for these outbreaks of herpes virus infections is available, doctors should carefully monitor their patients on protease inhibitors for signs of CMV retinitis or any other herpes infection. For their part, patients should alert their doctor to any change in their vision, such as flashes or floaters, as soon as possible. |
