H30.9 + (B20.2)
DESCRIPTION
Cytomegalovirus (CMV) retinitis is seen in advanced HIV infection, with CD4 count <100 cells/mm 3 . The characteristic retinal appearance is that of necrosis, i.e. white exudates, and hemorrhages at the edges of the exudates. Visual loss is irreversible – the goal of therapy is to limit further loss.
MEDICINE TREATMENT
Limited CMV retinitis:
- Valganciclovir, oral, 900 mg 12 hourly for the first 3 weeks, then 900 mg daily until immune recovery (CD4 > 100) and a minimum of 3 months of therapy with valganciclovir (if available).
- Monitor FBC weekly during induction, then monthly as valganciclovir can cause bone marrow suppression. Avoid concomitant zidovudine use.
- Initiate ART 2 weeks after starting induction therapy.
If valganciclovir is not available:
- Ganciclovir, intravitreal, 2 mg once a week (specialist).
- Once immune function has been restored with antiretroviral therapy (CD4 >100) and the features of active retinitis has cleared, maintenance ganciclovir can be stopped but monitor for recurrence.
REFERRAL
To ophthalmologist for confirmation of diagnosis.