What Is CMV?
CMV is short for cytomegalovirus, a herpes virus. It is a virus which most o
ften causes illness in the retina of the eyes or the
intestines (gut) in people with HIV. But CMV infects your whole body, and
can also cause illness in your lungs, throat, brain,
kidneys, gall bladder, liver and other organs. CMV of the eyes is called CMV
retinitis. It is the disease which most often causes
people with AIDS to go blind. CMV of the colon is called CMV colitis.
What Are the Signs of CMV?
People with CMV retinitis have blurry vision, unusual changes in eyesight or
see small moving spots called floaters. You may
also feel as if a shade is drawn over your eyes. People with CMV colitis
might have diarrhea, abdominal pain, weight loss,
fevers, loss of appetite, or trouble swallowing. CMV can also cause painful
neuropathy (tingling in the hands or feet), or
jaundice (turning yellow). If you have any of these signs, you should see
your doctor right away -- early diagnosis is important.
Can CMV Be Prevented?
There are no drugs that can prevent illness from CMV. Although some people
take Acyclovir (Zovirax), to prevent CMV
illness, studies have shown that it does not work. Other drugs are being
studied in clinical trials to prevent CMV illness.
Most people already have CMV virus in their body, but it does not make them
sick, even if they are HIV-infected. Most
people who do develop illness from CMV have a very low t-cell count. Your
doctor can perform a blood test to see if you
have been exposed to CMV.
Can CMV Be Treated?
There are two standard treatments for CMV disease -- gancyclovir and
foscarnet. Neither of these drugs will cure CMV, but
they can stop CMV from getting worse. Both drugs require a daily infusion,
meaning that the drug has to be given in the vein
every day for about 2 - 4 hours. People who get CMV treatment usually have a
tube called a catheter inserted in their chest
(called a Hickman catheter) or their arm (called a PICC line) that makes it
easier to give the infusion. The catheter must be
bandaged and kept clean and dry. Because the drugs only slow down the
illness, treatment must continue for the rest of your
life and you must see your doctor regularly to make certain that the CMV
illness is not getting worse. Very often these drugs
will not work well or will have toxic side effects that make you sick.
Doctors will then increase the dose and/or switch to the
other drug. Some doctors use both drugs in combination. Some studies have
shown foscarnet to be more effective than
gancyclovir, but it can also have more toxic side effects and it requires a
more lengthy, daily infusion. There are medicines,
which might be better and easier to take, that are being tested in clinical
trials now.
What Are the Side Effects of the CMV Treatments?
The most common side effect from gancyclovir is neutropenia (low white blood
cells). It is usually reversible if you stop taking
the drug. Neutropenia can also be treated with G-CSF (Neupogen) and/or
GM-CSF, both drugs that are given by injection.
AZT can also cause neutropenia, so if taking both AZT and gancyclovir, close
monitoring of your white blood cell count is very
important. Other gancyclovir side effects: anemia, fever, rash, abnormal
liver functions. Foscarnet can cause serious kidney
damage and nausea and skin ulcerations. Both drugs require careful
monitoring. Another very difficult side effect of both drugs
is the possibility of developing infections from the catheter. It is very
important to keep the catheter clean and dry and to change
the bandage that covers it regularly. Infections from the catheter can be
very dangerous and should be treated immediately by
your doctor.
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