0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Special Article |

Guidelines for the Treatment of Cytomegalovirus Diseases in Patients With AIDS in the Era of Potent Antiretroviral Therapy:  Recommendations of an International Panel

Richard J. Whitley, MD; Mark A. Jacobson, MD; Dorothy N. Friedberg, MD, PhD; Gary N. Holland, MD; Douglas A. Jabs, MD; Douglas T. Dieterich, MD; W. David Hardy, MD; Michael A. Polis, MD, MPH; Thomas A. Deutsch, MD; Judith Feinberg, MD; Stephen A. Spector, MD; Sharon Walmsley, MD, FRCPC; W. Lawrence Drew, MD, PhD; William G. Powderly, MD; Paul D. Griffiths, MD; Constance A. Benson, MD; Harold A. Kessler, MD ; for the International AIDS Society–USA
Arch Intern Med. 1998;158(9):957-969. doi:10.1001/archinte.158.9.957.
Text Size: A A A
Published online

Objective  To provide recommendations for the treatment of acquired immunodeficiency syndrome–related cytomegalovirus (CMV) end-organ diseases, including retinitis, colitis, pneumonitis, and neurologic diseases.

Participants  A 17-member panel of physicians with expertise in clinical and virological research and in-patient care in the field of CMV diseases.

Evidence  Available clinical and virological study results. Recommendations are rated according to the quality and strength of available evidence. Recommendations were limited to the treatment of CMV diseases; prophylaxis recommendations are not included.

Process  The panel was convened in February 1997 and met regularly through November 1997. Subgroups of the panel summarized and presented available information on specific topics to the full panel; recommendations and ratings were determined by group consensus.

Conclusions  Although the epidemiological features of CMV diseases are changing in the setting of potent, combination antiretroviral therapy, continued attention must be paid to CMV diseases in patients infected with the human immunodeficiency virus to prevent irreversible end-organ dysfunction. The initial and maintenance treatment of CMV retinitis must be individualized based on the characteristics of the lesions, including location and extent, specific patient factors, and characteristics of available therapies among others. Management of relapse or refractory retinitis must be likewise individualized. Ophthalmologic screening for patients at high risk for retinitis or who have a prior diagnosis of extraretinal disease is recommended. Recommendations for gastrointestinal, pulmonary, and neurologic manifestations are included.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Place holder to copy figure label and caption

A, The anatomical zones of the retina. Zone 1 encompasses less than 10% of the total retina and includes the area surrounding the optic disc and fovea; lesions here are considered to be immediately threatening to sight. Zone 2 is the midperipheral retina; zone 3, the far peripheral retina. Zone 3 includes the area of attachment of the vitreous base, and necrotic holes that develop here have the highest risk of leading to retinal detachments. B, The posterior portion of the fundus, with the border separating zones 1 and 2 indicated. The photograph corresponds to the approximate area that can be examined with the handheld, monocular direct ophthalmoscope. C, A photographic montage of a fundus, showing a peripheral lesion in the anterior portion of zone 2 and in zone 3. This lesion could only be visualized with an indirect ophthalmoscope. Panels A and B reprinted from Holland et al15 with permission, copyright 1989. Panel C was reprinted courtesy of the Studies of the Ocular Complications of AIDS Research Group.

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 96

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();