Freqüência da terapia de indução e reindução do ganciclovir no tratamento da retinite por citomegalovírus

Matos, Kimble T. F.; Muccioli, Cristina

doi:10.5935/0004-2749.19970004

RESUMO

Introdução:

A retinite pelo citomegalovírus (CMV) é a infecção ocular mais freqüente nos pacientes com a síndrome de imunodeficiência adquirida (AIDS). O ganciclovir é utilizado como droga de escolha para o tratamento e controle de progressão da doença.

Objetivos:

Determinar a freqüência do uso da terapia de indução e reindução de ganciclovir no tratamento da retinite por CMV.

Métodos:

Estudo retrospectivo de 1100 pacientes infectados pelo HIV, sendo 407 (37%) com manifestações oculares. Duzentos e quarenta e seis (22,4%) apresentavam retinite por CMV.

Resultados:

Noventa e nove (40,2%) pacientes necessitaram de tratamento inicial com terapia de indução de ganciclovir (10 mg/kg/dia por 21 dias) e outros 147 (59,8%) estavam usando a terapia de manutenção de 5 mg/kg/dia. Trinta (12,2%) pacientes necessitaram terapia de reindução.

Conclusões:

A taxa de recidiva dos nossos pacientes foi significativamente menor quando comparada com a literatura. Nós atribuímos a alta taxa de abandono do tratamento ao efeito tóxico, inconveniente e prolongado da terapêutica.

Palavras-chave:
AIDS; Retinite; Citomegalovírus; Ganciclovir; Inflamação ocular

SUMMARY

Background:

Cytomegalovirus (CMV) retinitis is the most common ocular infection in patients with the acquired immunodeficiency syndrome (AIDS). Ganciclovir is used to contrai the spread of CMV.

Purpose:

To investigate the incidence of use of induction and reinduction therapy of ganciclovir in treatment of CMV retinitis in a reference center for ocular complications of AIDS.

Methods:

We evaluated retrospectively 1,100 HIV-infected patients, 407 (37%) with ocular manifestations. From the total, 246 (22.4%) patients presented CMV retinitis.

Results:

Ninety nine (40.2%) patients required an induction therapy of 10 mg/kg/day of ganciclovir for 21 days and the others 147 (59.8%) were using a maintenance therapy of 5 mg/kg/day. Thirty (1 2.2%) patients required a reinduction therapy.

Conclusions:

The relapsed ratio of our patients was significantly lower when compared with literature ⁶6 JABS, D. A.; ENGER, C.; BARTLETT, J. G. - Cytomegalovirus retinitis and acquired immunodeficience syndrome. Arch Ophthalmol, 107: 75-80, 1989.^,¹²12 BUHLES, Jr. W. C.; MASTRE, B. J.; TINKER, A. J.; et al. - Ganciclovir treatment of life or sightthreatening cytomegalovirus infection: Experience in 314 immunocompromised patients. Rev Infect Dis, 10(Suppl3): S 495-503, 1988.. We atribule this ratio to the toxicity, spending time, and, the very inconvenient therapy.

Key-words:
AIDS; Cytomegalovirus; Retinitis; Ganciclovir; Intraocular inflammation

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REFERÊNCIAS BIBLIOGRÁFICAS

¹
HOLLAND, G. N.; TUFAIL, A.; JORDAN, M. C. - Cytomegalovirus diseases. Ocular Infection & Immunity. Pepose J S, Holland G N, Wilhelmus K R. Mosby, 1088-1128, 1996.
²
HOLLAND, G. N.; SISON, R. F.; JATULIS, D. E. et al. - Survival of patients with the acquired immunedeficiency syndrome after development of cytomegalovirus retinopathy. Ophthalmology, 97: 204-11, 1990.
³
CENTERS FOR DISEASE CONTROL - Revision of the Centers for Disease Control surveillance case definition for acquired immunodeficiency syndrome. MMWR, 36(supp): 1S-16S, 1987.
⁴
PALESTINE, A. G.; RODRIGUES, M. M.; MACHER, A. M.; et al. - Ophthalmic involvement in acquired immunodeficiency syndrome. Ophthalmology, 91: 1092-1099, 1994.
⁵
MATTEWS, T.; BOEHME, R. - Antiviral activity and mechanism of action of ganciclovir. Rev Infect Dis, 10(Suppl 3): S, 490-4, 1988.
⁶
JABS, D. A.; ENGER, C.; BARTLETT, J. G. - Cytomegalovirus retinitis and acquired immunodeficience syndrome. Arch Ophthalmol, 107: 75-80, 1989.
⁷
HOLLAND, G. N.; SIDIKARO, Y.; KREIGER, A. E.; HARDY, D.; SAKAMOTO, M. J.; FRENKEL, L. M.; WINSTON, D. J.; GOTTLIEB, M. S.; BRYSON, Y. J.; CHAMPLIN, R. E.; HO, W. G.; WINTERS, R. E.; WOLFE, P. R.; CHERRY, J. D. - Treatment of cytomegalovirus retinopathy with ganciclovir. Ophthalmology, 94: 815-823, 1987.
⁸
SOUCY, D. - Ganciclovir (Cytovene^Ⓚ) in the treatment of cytomegalovirus retinitis. Conn Med, 55(6): 345-8, 1991.
⁹
HOLLAND, G. N.; BUHLES, W. C.; MASTRE, B.; et al. - A controlled retrospective study on ganciclovir treatment for cytomegalovirus retinopathy: Use of standardized system for the assessment of disease outcome. Arch Ophthalmol, 107: 1759-1766, 1989.
¹⁰
THE CYTOMEGALOVIRUS RETREATMENT TRIAL - Combination Foscarnet and Ganciclovir therapy vs monotherapy for the treatment of relapsed cytomegalovirus retini tis in patients with AIDS. Arch Ophthalmol , 114: 23-33, 1996.
¹¹
MUCCIOLI, C.; BELFORT, JR. R.; LOTTENBERG, C.; LIMA, J.; SANTOS, P.; KIM, M.; ABREU, M.; NEVES, R. - Achados Oftalmológicos em AIDS: Avaliação de 445 casos, atendidos em 1 ano. Rev. Assoc. Med. Bras., 40: 155-8, 1994.
¹²
BUHLES, Jr. W. C.; MASTRE, B. J.; TINKER, A. J.; et al. - Ganciclovir treatment of life or sightthreatening cytomegalovirus infection: Experience in 314 immunocompromised patients. Rev Infect Dis, 10(Suppl3): S 495-503, 1988.
¹³
STUDIES OF OCULAR COMPLICATIONS OF AIDS RESEARCH GROUP, IN COLLABORATJON WITH THE AIDS CLINICAL TRIALS GROUP. - Foscarnet-ganciclovir cytomegalovirus retinitis trial, 4: visual outcomes. Ophthalmology, 101: 1250-1261, 1994.
¹⁴
RAHHAL, F. M.; AREVALO, F.; MUNGUIA, D.; TASKINTUNA, I.; DE LA PAZ, E. C.; AZEN, S. P.; FREEMAN, W. R. - Intravitreal cidofovir for the maintenance treatment of cytomegalovirus retinitis. Ophthalmology, 103: 1078-1083, 1996.

Datas de Publicação

Publicação nesta coleção
Dec 1997

Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribution, que permite uso, distribuição e reprodução em qualquer meio, sem restrições desde que o trabalho original seja corretamente citado.

[1] ¹
HOLLAND, G. N.; TUFAIL, A.; JORDAN, M. C. - Cytomegalovirus diseases. Ocular Infection & Immunity. Pepose J S, Holland G N, Wilhelmus K R. Mosby, 1088-1128, 1996.

[2] ²
HOLLAND, G. N.; SISON, R. F.; JATULIS, D. E. et al. - Survival of patients with the acquired immunedeficiency syndrome after development of cytomegalovirus retinopathy. Ophthalmology, 97: 204-11, 1990.

[3] ³
CENTERS FOR DISEASE CONTROL - Revision of the Centers for Disease Control surveillance case definition for acquired immunodeficiency syndrome. MMWR, 36(supp): 1S-16S, 1987.

[4] ⁴
PALESTINE, A. G.; RODRIGUES, M. M.; MACHER, A. M.; et al. - Ophthalmic involvement in acquired immunodeficiency syndrome. Ophthalmology, 91: 1092-1099, 1994.

[5] ⁵
MATTEWS, T.; BOEHME, R. - Antiviral activity and mechanism of action of ganciclovir. Rev Infect Dis, 10(Suppl 3): S, 490-4, 1988.

[6] ⁶
JABS, D. A.; ENGER, C.; BARTLETT, J. G. - Cytomegalovirus retinitis and acquired immunodeficience syndrome. Arch Ophthalmol, 107: 75-80, 1989.

[7] ⁷
HOLLAND, G. N.; SIDIKARO, Y.; KREIGER, A. E.; HARDY, D.; SAKAMOTO, M. J.; FRENKEL, L. M.; WINSTON, D. J.; GOTTLIEB, M. S.; BRYSON, Y. J.; CHAMPLIN, R. E.; HO, W. G.; WINTERS, R. E.; WOLFE, P. R.; CHERRY, J. D. - Treatment of cytomegalovirus retinopathy with ganciclovir. Ophthalmology, 94: 815-823, 1987.

[8] ⁸
SOUCY, D. - Ganciclovir (Cytovene^Ⓚ) in the treatment of cytomegalovirus retinitis. Conn Med, 55(6): 345-8, 1991.

[9] ⁹
HOLLAND, G. N.; BUHLES, W. C.; MASTRE, B.; et al. - A controlled retrospective study on ganciclovir treatment for cytomegalovirus retinopathy: Use of standardized system for the assessment of disease outcome. Arch Ophthalmol, 107: 1759-1766, 1989.

[10] ¹⁰
THE CYTOMEGALOVIRUS RETREATMENT TRIAL - Combination Foscarnet and Ganciclovir therapy vs monotherapy for the treatment of relapsed cytomegalovirus retini tis in patients with AIDS. Arch Ophthalmol , 114: 23-33, 1996.

[11] ¹¹
MUCCIOLI, C.; BELFORT, JR. R.; LOTTENBERG, C.; LIMA, J.; SANTOS, P.; KIM, M.; ABREU, M.; NEVES, R. - Achados Oftalmológicos em AIDS: Avaliação de 445 casos, atendidos em 1 ano. Rev. Assoc. Med. Bras., 40: 155-8, 1994.

[12] ¹²
BUHLES, Jr. W. C.; MASTRE, B. J.; TINKER, A. J.; et al. - Ganciclovir treatment of life or sightthreatening cytomegalovirus infection: Experience in 314 immunocompromised patients. Rev Infect Dis, 10(Suppl3): S 495-503, 1988.

[13] ¹³
STUDIES OF OCULAR COMPLICATIONS OF AIDS RESEARCH GROUP, IN COLLABORATJON WITH THE AIDS CLINICAL TRIALS GROUP. - Foscarnet-ganciclovir cytomegalovirus retinitis trial, 4: visual outcomes. Ophthalmology, 101: 1250-1261, 1994.

[14] ¹⁴
RAHHAL, F. M.; AREVALO, F.; MUNGUIA, D.; TASKINTUNA, I.; DE LA PAZ, E. C.; AZEN, S. P.; FREEMAN, W. R. - Intravitreal cidofovir for the maintenance treatment of cytomegalovirus retinitis. Ophthalmology, 103: 1078-1083, 1996.

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