The ganciclovir implant plu oral ganciclovir veru parenteral cidofovir for the treatment of cytomegaloviru retiniti in patient with acquired immunodeficiency yndrome: The Ganciclovir Cidofovir Cytomegaloviru Retiniti Trial

PURPOE: To compare the regimen of the ganciclovir implant plu oral ganciclovir to one of intravenou cidofovir for the treatment of cytomegaloviru retiniti. METHOD: ixty-one patient with acquired immunodeficiency yndrome and cytomegaloviru retiniti were randomized either to the regimen of the ganciclovir implant plu oral ganciclovir, 1 gm three time daily, or intravenou cidofovir, 5 mg/kg once weekly for two doe, followed by 5 mg/kg every other week. REULT: Mortality wa imilar between the two treatment group. Mortality rate were 0.41 per peron-year in patient aigned to the ganciclovir regimen and 0.49 per peron-year in patient aigned to cidofovir (P = .59). Ocular outcome were imilar between the two group. Retiniti progreion occurred at a rate of 0.67 per peron-year in the ganciclovir group and 0.71 per peron-year in the cidofovir group (P = .72). A lo of viual acuity of 15 letter or more occurred at a rate of 0.78 per peron-year in the ganciclovir group and 0.47 per peron-year in the cidofovir group (P = .28). The rate of lo of viual field wa 7 degree per month in the ganciclovir group and 2 degree per month in the cidofovir group (P = .048). Vitreou hemorrhage wa more common in the ganciclovir implant group (0.13 per peron-year) than in the cidofovir group (no cae, P = .014), wherea uveiti appeared to be more common in the cidofovir group (0.35 per peron-year) than in the ganciclovir group (0.09 per peron-year, P = .066). Nephrotoxicity (erum creatinine 1.6 mg/dL or greater) occurred at a rate of 0.18 per peron-year in the ganciclovir group and 0.48 per peron-year in the cidofovir group (P = .10). CONCLUION: Although the mall number of patient in thi tudy limit definitive interpretation, thee data ugget that in the era of highly active antiretroviral therapy, the regimen of the ganciclovir implant plu oral ganciclovir and of intravenou cidofovir are imilar for controlling cytomegaloviru retiniti and preventing viual lo but have different ide effect