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CMV retinitis and ARv

Posted: Aug 31, 2007

QUESTION:

Hello I have a 37year-old patient with a CD4 cell count on 325 and CMV retinitis (I have never seen a CMV retinitis with so much CD4 cells). I will start valganciclovir in an ambulatory basis as soon as I get it . He is otherwise in good clinical condition. I will also start ARV but I have doubts about when to start: right now or after induction therapy with valganciclovir. Another question: how long should I keep him on mainteinance therapy with valganciclovir as he starts with 325 CD4s? Which parameter should I use? Clinical improvement?


  

RESPONSE FROM:   

    CMV retinitis is rare at higher CD4 cell counts but not unheard of. It would be interesting to know the CD4%. If this is low, I would follow the CD4% when determining the duration of maintenance therapy. Certainly a CD4% over 14% would be a minimal level to consider discontinuation.

    If the CD4% is not too bad, I might consider valganciclovir at 900 mg daily indefinitely. One could arbitrarily think of stopping at some high level such as a CD4 count of 500.

    I would start ART but would probably wait until after induction therapy with valganciclovir is completed.

    DW




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