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PURPOSE: To evaluate the impact of foscarnet on the longevity of persons with human immunodeficiency virus, type 1 (HIV-1) infection and cytomegalovirus (CMV) retinitis. PATIENTS AND METHODS: A cohort of 24 patients with acquired immunodeficiency syndrome (AIDS) and CMV retinitis received sodium phosphonoformate (foscarnet) as part of a controlled efficacy trial at the National Institutes of Health. Foscarnet was continued for as long as it was tolerated. Antiretroviral therapy was given to the patients as tolerated. Long-term follow-up was available on all patients. RESULTS: Seventeen patients received zidovudine during or after receiving foscarnet, 2 patients received dideoxyinosine, 2 patients zidovudine and dideoxyinosine, and 3 patients received no specific antiretroviral agent. Patients received foscarnet for a mean of 6.2 months (median, 4 months; range, 10 days to 22 months). Ten patients required a change to ganciclovir therapy at some time after receiving foscarnet. The median time from the diagnosis of CMV retinitis until death was 13.5 months (range, 3 to 34 months). Patients lived longer than untreated or ganciclovir-treated historical controls with AIDS and CMV retinitis. There was no difference in the survival of patients treated with foscarnet at the time of diagnosis and those patients treated with foscarnet only after progression of their CMV retinitis. CONCLUSIONS: These data suggest that loscarnet may prolong the survival of persons with AIDS and CMV retinitis and should be the initial treatment of choice in these patients.

The virus that causes AIDS attacks and destroys cells in the immune system, the body's natural defense system for fighting infection. This explains why patients with AIDS are so susceptible to infections. Cytomegalovirus (CMV) retinitis (inflammation of the retina) is a type of eye infection that is estimated to occur in five percent of patients with AIDS. Ganciclovir has been reported to be effective in treating CMV retinitis in 81 to 97 percent of the AIDS patients. However, many patients suffer a relapse within eight weeks and others develop neutropenia (abnormally low number of white blood cells) as a result of ganciclovir treatment. Foscarnet is another antiviral drug that may be useful for treating CMV retinitis, but it is toxic to the kidneys; it is estimated to cause kidney damage in 20 to 50 percent of patients. In addition, foscarnet can cause anemia (abnormally low number of red blood cells), muscle twitching and nausea. However, foscarnet may be useful for treating AIDS patients who already have advanced stage kidney disease and can not be treated with ganciclovir. This article describes the case of a 32-year-old black man with AIDS who developed kidney failure. As a result, the patient was dependent on hemodialysis. Two years after beginning dialysis treatment he developed CMV retinitis. The retinitis stabilized during 14 weeks of foscarnet therapy. However, the patient developed several other AIDS-related complications during that period and died. The authors suggest that foscarnet may be a useful alternative for treating CMV retinitis in AIDS patients who are receiving hemodialysis. (Consumer Summary produced by Reliance Medical Information, Inc.)

The human immunodeficiency virus (HIV) is the viral agent that causes AIDS. This virus destroys the immune system (the body's natural defense system for fighting infection) and sharply diminishes the abilities of HIV-infected patients to fight infection. Consequently, these patients are more susceptible to other types of infections. Infection with cytomegalovirus (CMV) frequently occurs in patients with AIDS, and it is the most common cause of blindness in these patients. CMV causes inflammation inside of the eye (retinitis), damaging the portion of the eye that is sensitive to light (the retina). Ganciclovir is the drug that is used to treat retinitis in AIDS patients. However, some types of CMV are resistant to (not killed by) this drug. The authors describe the cases of two AIDS patients with retinitis who did not respond to treatment with ganciclovir. Both patients were being treated with zidovudine (AZT) for AIDS. They developed CMV retinitis one year and two years, respectively, after AIDS was diagnosed. They were treated with ganciclovir, but the retinitis continued to become worse in both cases. When the patients were treated with foscarnet (another antiviral drug), retinitis stabilized. However, 12 and 25 weeks, respectively, after treatment with foscarnet, the retinitis started to worsen. These findings suggest that foscarnet may be beneficial in treating AIDS patients with CMV retinitis that does not respond to treatment with ganciclovir. (Consumer Summary produced by Reliance Medical Information, Inc.)

Objective: To identify ocular and systemic factors that predict advancement of cytomegalovirus (CMV) retinitis during treatment. Methods: Patients with acquired immunodeficiency syndrome were enrolled in a multicenter clinical trial designed to evaluate foscarnet sodium and ganciclovir sodium as therapy tot newly diagnosed CMV retinitis. Ocular characteristics at baseline and measurements of retinitis were assessed from fundus photographs by graders at a fundus photograph reading center. The following measures of advancement were assessed: (1) lesion border movement of at least 750 [micro]m or development of a new lesion in involved eyes; (2) rate of increase in retinal area with CMV in revolved eyes; and (3) development of retinitis in uninvolved eyes of patients with unilateral disease at baseline. Results: In eyes with retinitis, risk factors at baseline for advancement while receiving treatment included smaller area involved, active margins of retinitis, and posterior location. Risk factors for development of retinitis in uninvolved fellow eyes included blood and urine cultures positive for CMV and lower [CD8.sup.+] T-lymphocyte count. Conclusions: Lesion characteristics can be used to predict advancement of preexisting disease, whereas only systemic factors are associated with development of bilateral disease. These analyses describe retinitis activity before the introduction of potent antiretroviral therapies but provide an important reference point for patients in whom CMV retinitis develops after failure or intolerance of antiretroviral agents. Arch Ophthalmol. 2000;118:1196-1204