Treatment for CMV Gastrointestinal Disease:

Dieterich et al. treated 62 AIDS patients with biopsy-proven CMV colitis with ganciclovir (5 mg/kg IV twice daily) or placebo for 14 days. At entry all patients had diarrhea (>6 stools/day), malabsorption, or unintentional weight loss of >4.5 kg. After 14 days, the groups did not differ for clinical end points (diarrhea, temperature, body weight, abdominal pain, fatigue, serum albumin, cholesterol or magnesium) or for adverse effects. A reduction in colonoscopy scores from baseline to day 14 was seen in 20/32 (62.5%) subjects treated with ganciclovir compared to 11/30 (36.7%) placebo recipients (P = .042) CMV disease at new sites developed in seven placebo recipients (5 retinitis, 1 gastritis, 1 pneumonitis) and three ganciclovir recipients (3 gastritis). The- investigators suggest that the treatment might be more effective if extended to 21 or 28 days.

A randomized controlled study compared ganciclovir with foscarnet for induction therapy in patients with CMV gastrointestinal disease (Blanshard et al.). Nineteen patients were randomized to receive ganciclovir and 25 patients to foscarnet. Mean duration of treatment was 15 days. Endoscopic improvement was observed in 84% and 81% of ganciclovir and foscarnet subjects, respectively. Adverse drug effects occurred with equal frequency in both groups.

Dietrich et al. treated 10 patients, 5 with upper GI CMV disease and 5 with lower GI disease with foscarnet (90 mg/kg IV q12h). Mild edema was noted in 2/10 patients (20%) but resolved. 8/10 patients (80%) required 6 weeks of treatment for complete response. 9/10 (90%) responded histopathologically (P =.0067) and 9/10 responded endoscopically (P =.0004).

A phase III randomized, open-label trial of foscarnet for the treatment of CMV colitis is currently underway.