Journal Article

Effect of a 14-Day Course of Foscarnet on Cytomegalovirus (CMV) Blood Markers in a Randomized Study of Human Immunodeficiency Virus-Infected Patients with Persistent CMV Viremia

Dominique Salmon-Célron, Anne-Marie Fillet, Jean-Pierre Aboulker, Laurence Gérard, Nadira Houhou, Isabelle Carriére, Juliette Ostinelli, Jean-Louis Vildé, Françoise Brun-Vézinet and Catherine Leport

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 28, issue 4, pages 901-905
Published in print April 1999 | ISSN: 1058-4838
Published online April 1999 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/515223
Effect of a 14-Day Course of Foscarnet on Cytomegalovirus (CMV) Blood Markers in a Randomized Study of Human Immunodeficiency Virus-Infected Patients with Persistent CMV Viremia

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A randomized open-label phase 2 trial compared the virological and clinical effects on cytomegalovirus (CMV) infection of a 14-day course of intravenous foscarnet (100 mg/[kg · 12 h]) or no treatment in 42 HIV-infected patients with <100 CD4 cells/mm3 and persistent asymptomatic CMV viremia. All CMV markers (blood culture, pp65 antigenemia, plasma and leukocyte DNA) either became negative or decreased significantly at day 14 in the foscarnet group. CMV blood culture results at day 14 were positive in 14% of those receiving foscarnet versus 60% of control patients (P = .004). However, after the end of treatment, all markers reappeared or the virus load rapidly increased. The probability of CMV disease at 6 months was 43% in both groups. Patients who had or who achieved a negative blood culture at any time had a reduced risk of CMV disease (RR = 2.64; 95% CI = 1.24−5.62; P = .02). This study suggests that sequential courses of intravenous foscarnet might not be a good strategy for preemptive therapy in this population and that in patients with a positive blood marker, treatment able to induce and maintain negative CMV blood cultures could constitute an effective intervention.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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