CYTOMEGALOVIRUS ESOPHAGITIS IN AIDS - A PROSPECTIVE EVALUATION OF CLINICAL-RESPONSE TO GANCICLOVIR THERAPY, RELAPSE RATE, AND LONG-TERM OUTCOME
CYTOMEGALOVIRUS ESOPHAGITIS IN AIDS - A PROSPECTIVE EVALUATION OF CLINICAL-RESPONSE TO GANCICLOVIR THERAPY, RELAPSE RATE, AND LONG-TERM OUTCOME
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DOI：
10.1016/s0002-9343(99)80400-8
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发表时间：
1995-02-01
影响因子：
5.9
通讯作者：
SCHWARTZ, DA
中科院分区：
文献类型：
--
作者：
WILCOX, CM;STRAUB, RF;SCHWARTZ, DA
目得：虽然巨细胞病毒（CMV）食管炎是获得性免疫缺陷综合征的一个重要并发症，但很少有研究专门针对目前可用的抗病毒治疗的反应，没有维持治疗的复发率和长期结果。在45个月的时间里，44例经内镜和组织病理学证实的OMV食管炎患者前瞻性地从所有人类免疫缺陷病毒（HIV）感染的患者进行内窥镜检查。诱导治疗包括静脉注射更昔洛韦10 mg/kg/天，持续约14天。膦甲酸酯给予60 mg/kg，每8小时为无反应者更昔洛韦。结果：这些患者中，35完成诱导更昔洛韦治疗，导致在17（49%）和10（29%）的部分反应，产生77%的总反应率。8例无反应者中有7例随后接受膦甲酸治疗，5例患者出现临床反应。在18例对更昔洛韦或膦甲酸随访的最终完全反应者中，7例（39%）在中位4个月（范围2至18个月）复发。在所有病例中，复发表现为复发性吞咽痛。再诱导更昔洛韦治疗产生了一个完全反应，在2例患者的部分反应，和诱导膦甲酸治疗导致在其他治疗患者的完全反应。在长期随访中，1例完全应答者发生CMV结肠炎伴并发视网膜炎，另外4例患者发生视网膜炎。诊断后的中位生存期为8.2个月，但有4例患者生存期超过1年。没有患者死亡的直接结果食管疾病，虽然溃疡相关的出血可能导致死亡的2例终末期肝病和肝性encephalopathy.Conclusions：CMV食管炎有一个良好的反应，诱导更昔洛韦治疗，和长期缓解后可能会发生单独的诱导治疗。尽管对更昔洛韦治疗有良好的反应，但长期生存率很差，反映了这些患者的严重免疫缺陷。
PURPOSE: Although cytomegalovirus (CMV) esophagitis is an important complication of acquired immunodeficiency syndrome, there has been little study specifically addressing the response to currently available antiviral therapy, relapse rate without maintenance therapy, and long-term outcome.PATIENTS AND METHODS: Over a 45-month period, 44 patients with OMV esophagitis established endoscopically and histopathologically were prospectively identified from among all human immunodeficiency virus (HIV)-infected patients undergoing endoscopy. Induction therapy consisted of intravenous ganciclovir at 10 mg/kg per day for approximately 14 days. Foscarnet was given at 60 mg/kg every 8 hours for nonresponders to ganciclovir.RESULTS: Of these patients, 35 completed induction ganciclovir therapy, resulting in a complete response in 17 (49%) and a partial response in 10 (29%), yielding a 77% overall response rate. Seven of 8 nonresponders were subsequently treated with foscarnet, with a clinical response seen in 5 patients. In the 18 eventual complete responders to ganciclovir or foscarnet followed up without maintenance therapy, 7 (39%) relapsed at a median of 4 months (range 2 to 18 months). In all cases, relapse was manifested by recurrent odynophagia. Reinduction ganciclovir therapy yielded a complete response in 1 patient and a partial response in 2, and induction foscarnet treatment resulted in a complete response in the other treated patients. During long-term followup, 1 complete responder developed CMV colitis with concurrent retinitis, and 4 other patients developed retinitis. The median survival after diagnosis was 8.2 months, although survival for greater than 1 year was seen in 4 patients. No patient died as a direct result of esophageal disease, although ulcer-related bleeding may have contributed to death in 2 patients with endstage liver diseases and hepatic encephalopathy.CONCLUSIONS: CMV esophagitis has a favorable response to induction ganciclovir therapy, and a long-term remission may occur after induction therapy alone. Despite the favorable response to ganciclovir therapy, the long-term survival is poor, reflecting the severe immunodeficiency of these patients.