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Foscarnet may be effective in preventing the progression of Kaposi's sarcoma (KS). KS is a skin tumor that occurs often in HIV patients. Researchers analyzed the progression of KS in 66 patients who were taking foscarnet or ganciclovir to treat cytomegalovirus infection. All of the patients also had a history of KS. In the patients taking foscarnet, it took an average of 211 days for a new tumor to develop or for an existing one to get bigger. In the patients taking ganciclovir, it took an average of 22 days.

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.

In some cases, using two drugs to treat an infection or a disease can be more advantageous than using only one drug. This is called combination drug therapy. One advantage of this method of treatment is that the dose of each drug can usually be reduced. This is important when the drugs being used have toxic side effects because using a lower dose of each drug will reduce side effects and toxicity. In addition, microorganisms are less likely to become resistant to drug treatment when two drugs are used simultaneously. Zidovudine (also called AZT) was the first drug that was shown to be effective in treating patients infected with the human immunodeficiency virus (HIV, which causes AIDS). However, recent studies have reported that the beneficial effects of zidovudine are limited, and that HIV may become resistant to zidovudine when it is used over long periods of time. Studies performed on cells grown in culture have shown that a combination of zidovudine and the drug foscarnet is more effective in killing HIV than either drug when used alone. Therefore, a study was performed to evaluate the effectiveness of combined therapy with zidovudine and foscarnet in six patients with HIV infection. The patients received treatment with zidovudine for 9 to 27 weeks prior to the beginning of the study. They received both zidovudine and foscarnet for two weeks, and were given zidovudine alone for the next six months. During the two-week period when both drugs were used, half the patients improved. However, 4 to 14 weeks later the beneficial effects of the combined treatment had disappeared. In treating HIV infections, it is possible that long-term treatment with both drugs will be required to maintain the beneficial effects of combination therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

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.)

An evaluation was carried out of the effectiveness of foscarnet, a drug that inhibits viral replication, for treating infections caused by varicella-zoster virus (a member of the herpesvirus family) in five AIDS patients. While foscarnet appears effective against herpes simplex virus infections that are resistant to acyclovir (the drug commonly used for treating these infections), its value for treating acyclovir-resistance varicella-zoster infections has not been demonstrated. The patients' skin sores (lesions) had not healed after a 10-day course of acyclovir. Laboratory tests showed the presence of varicella-zoster virus. When foscarnet was administered for an average of 21 days, complete healing of the lesions in three patients, and virtually complete healing in one other patient was noted. The fifth patient did not heal, and tests indicated that the virus remained present. The patients had all undergone a previous, successful course of treatment with acyclovir for zoster infection. The effects of antiviral treatment on viral susceptibility to antiviral drugs is discussed. Because foscarnet administration can lead to toxicity, it should be used only for patients whose disease justifies this risk and for whom acyclovir resistance can be demonstrated. (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