The drug of choice for cytomegalovirus retinitis in HIV patients: March 2007

Ans. B: Ganciclovir CMV infection is the commonest ocular infection in HIV. Cytomegalovirus (CMV) is a DNA virus in the family Herpesviridae known for producing large cells with nuclear and cytoplasmic inclusions called an "owl's eye" effect. While CMV is found in almost everyone, and is usually fought off by the immune system, for people who are immunocompromised, by diseases, transplants, or chemotherapy the virus is not adequately destroyed and can cause damage to the eye and the rest of the body. HIV positive persons are most at risk, especially when the CD4 cell count decreases. It is usually treated by antivirals such as ganciclovir or foscarnet, which can be taken orally, intravenously, injected directly into the eye (intravitreal injection). Ganciclovir has good antiviral propey against herpes simplex virus 1 and 2, Epstein-Barr virus, and is at least 100 times more potent an inhibitor of CMV replication in vitro than acyclovir. Fomivirsen is the first antisense drug as an intraocular injection for the treatment of cytomegalovirus retinitis.