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Special Article
May 11, 1998

Guidelines for the Treatment of Cytomegalovirus Diseases in Patients With AIDS in the Era of Potent Antiretroviral Therapy: Recommendations of an International Panel

Author Affiliations

From the University of Alabama at Birmingham School of Medicine (Dr Whitley); University of California, San Francisco, School of Medicine (Drs Jacobson and Drew); New York University School of Medicine, New York (Drs Dieterich and Friedberg); University of California, Los Angeles, School of Medicine (Drs Holland and Hardy); Johns Hopkins University School of Medicine, Baltimore, Md (Dr Jabs); National Institute of Allergy and Infectious Diseases, Bethesda, Md (Dr Polis); Rush Medical College, Chicago, Ill (Drs Deutsch, Benson, and Kessler); University of Cincinnati College of Medicine, Cincinnati, Ohio (Dr Feinberg); University of California, San Diego (Dr Spector); University of Toronto Department of Medicine, Toronto, Ontario (Dr Walmsley); Washington University School of Medicine, St Louis, Mo (Dr Powderly); and Royal Free Hospital School of Medicine, London, England (Dr Griffiths). Dr Benson is now with the Division of Infectious Disease, University of Colorado School of Medicine, Denver.

Arch Intern Med. 1998;158(9):957-969. doi:10.1001/archinte.158.9.957

Objective  To provide recommendations for the treatment of acquired immunodeficiency syndrome–related cytomegalovirus (CMV) end-organ diseases, including retinitis, colitis, pneumonitis, and neurologic diseases.

Participants  A 17-member panel of physicians with expertise in clinical and virological research and in-patient care in the field of CMV diseases.

Evidence  Available clinical and virological study results. Recommendations are rated according to the quality and strength of available evidence. Recommendations were limited to the treatment of CMV diseases; prophylaxis recommendations are not included.

Process  The panel was convened in February 1997 and met regularly through November 1997. Subgroups of the panel summarized and presented available information on specific topics to the full panel; recommendations and ratings were determined by group consensus.

Conclusions  Although the epidemiological features of CMV diseases are changing in the setting of potent, combination antiretroviral therapy, continued attention must be paid to CMV diseases in patients infected with the human immunodeficiency virus to prevent irreversible end-organ dysfunction. The initial and maintenance treatment of CMV retinitis must be individualized based on the characteristics of the lesions, including location and extent, specific patient factors, and characteristics of available therapies among others. Management of relapse or refractory retinitis must be likewise individualized. Ophthalmologic screening for patients at high risk for retinitis or who have a prior diagnosis of extraretinal disease is recommended. Recommendations for gastrointestinal, pulmonary, and neurologic manifestations are included.

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