Cytomegalovirus Retinitis and Viral Resistance: Prevalence of Resistance at Diagnosis, 1994

doi:10.1001/archopht.1996.01100140023002

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Vol. 114 No. 7, July 1996

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Cytomegalovirus Retinitis and Viral Resistance

Prevalence of Resistance at Diagnosis, 1994

Douglas A. Jabs, MD; J. P. Dunn, MD; Cheryl Enger, PhD; Michael Forman, MS; Neil Bressler, MD; Patricia Charache, MD; Cytomegalovirus Retinitis and Viral Resistance Study Group

Arch Ophthalmol. 1996;114(7):809-814.

Abstract

Objective
To determine the prevalence of cytomegalovirus (CMV) isolatesresistant to ganciclovir sodium or foscarnet sodium at the timeof diagnosis of CMV retinitis, prior to the initiation of therapy.

Design
Prospective epidemiologic study. Setting: An acquired immunodeficiencysyndrome ophthalmology clinic.

Patients
Patients with acquired immunodeficiency syndrome and newly diagnosedCMV retinitis.

Intervention
Culturing blood and urine samples for CMV and testing of allpositive isolates for sensitivity to ganciclovir and foscarnet.

Main Outcome Measure
Prevalence of the following: blood culture isolates resistantto ganciclovir (inhibitory concentration 50% [IC₅₀]>5.5 µmol/L)or foscarnet (IC₅₀>400 µmol/L) and urine culture isolatesresistant to ganciclovir or foscarnet.

Results
Forty-nine patients were enrolled during a 13-month period.Forty-four patients had blood culture samples that could beevaluated; of these, 66% were positive (59% of patients). Thirty-fourpatients had urine cultures that were evaluable; of these, 82%were positive (57% of patients). Overall, 78% of patients hadeither a urine or blood culture sample positive for CMV. Noblood culture isolates were resistant to ganciclovir, and only1 urine culture isolate (2% of patients) was resistant to ganciclovir.Three percent of blood culture isolates and 4% of urine cultureisolates (2% and 2% of patients, respectively) were resistantto foscarnet. Overall, 4% of patients had either a blood orurine culture isolate resistant to foscarnet.

Conclusion
Resistance to ganciclovir or foscarnet at the time of diagnosisof CMV retinitis is uncommon.

Author Affiliations

From the Departments of Ophthalmology (Drs Jabs, Dunn, and Bressler), Oncology (Dr Enger), Pathology (Mr Forman and Dr Charache), and Medicine (Dr Jabs), The Johns Hopkins University School of Medicine, Baltimore, Md. Members of the Cytomegalovirus and Viral Resistance Study Group are listed in a box on page 811.

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