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1 April 2007

Volume 44, Number 7
Clinical Infectious Diseases 2007;44:1001–1008
© 2007 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4407-0021$15.00
DOI: 10.1086/512368
HIV/AIDS MAJOR ARTICLE

Change over Time in Incidence of Ganciclovir Resistance in Patients with Cytomegalovirus Retinitis

Barbara K. Martin,1

Michelle O. Ricks,2

Michael S. Forman,3 and

Douglas A. Jabs,1,2,4,a for

the Cytomegalovirus Retinitis and Viral Resistance Study Groupb

1Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, and Departments of 2Ophthalmology, 3Pathology, and 4Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland

Background.In the mid‐1990s, the incidence of cytomegalovirus (CMV) resistance to ganciclovir was estimated to be 25% by 1 year after diagnosis of retinitis in patients with acquired immunodeficiency syndrome.

Methods.Two hundred fifty‐seven patients with CMV retinitis were enrolled in a prospective observational study during 1993–2003 and were treated with ganciclovir. Demographic characteristics and data on CMV disease, antiretroviral therapy, and ganciclovir resistance were recorded for all patients. Human immunodeficiency virus (HIV) load and CMV load were measured for patients enrolled in 1996 or later. Kaplan‐Meier and Cox proportional hazards regression methods were used to examine incidence of resistance.

Results.The 2‐year incidence of resistance was 28% among patients enrolled before 1996 and 9% among those enrolled in or after 1996 ( ). All cases of resistance occurred among patients with CD4+ T cell counts <50 cells/μL, and positive CMV culture results at baseline were associated with a 4‐fold increase in resistance. Among patients whose CMV and HIV loads were measured, a detectable CMV load at baseline and during follow‐up was associated with increased risk of resistance, but a detectable HIV load was not.

Conclusions.Rates of resistance have decreased from the high levels seen in the pre‐HAART era. Better control of CMV replication may have contributed to this decrease.

Received 1 September 2006; accepted 28 December 2006; electronically published 20 February 2007.

Correspondence: Dr. Barbara K. Martin, Johns Hopkins Center for Clinical Trials, 615 N. Wolfe St., Ste. W5010, Baltimore, MD 21205 (). Reprints: Dr. Douglas A. Jabs, The Wilmer Eye Institute, 550 N. Broadway, Ste. 700, Baltimore, MD 21205 ().

Cited by

Robin K Avery. (2008) Update in management of ganciclovir-resistant cytomegalovirus infection. Current Opinion in Infectious Diseases 21:4, 433-437
Online publication date: 1-Sep-2008.
CrossRef
Sunwen Chou. (2008) Cytomegalovirus UL97 mutations in the era of ganciclovir and maribavir. Reviews in Medical Virology 18:4, 233-246
Online publication date: 1-Aug-2008.
CrossRef

  • Present affiliation: Department of Ophthalmology, The Mount Sinai School of Medicine, New York.

  • Members of the Cytomegalovirus Retinitis and Viral Resistance Study Group are listed at the end of the text.

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