In HIV-infected patients with advanced immunosuppression (CD4 <50 cells/µL), prophylaxis against Cytomegalovirus (CMV) retinitis is indicated. The drug used for CMV prophylaxis or pre-emptive therapy is:
- A Valganciclovir (oral prodrug of ganciclovir) ✓
- B Acyclovir (standard herpes prophylaxis dose)
- C Foscarnet intravenously only — oral prophylaxis not available for CMV
- D Valacyclovir at high doses (equivalent to CMV prophylaxis)
Explanation
Ganciclovir and its oral prodrug valganciclovir are the drugs of choice for CMV prophylaxis and treatment. Valganciclovir (900 mg once daily) achieves plasma ganciclovir levels equivalent to IV ganciclovir and is used for CMV retinitis treatment and prophylaxis in high-risk solid organ transplant recipients and HIV patients with CD4 <50. Acyclovir has poor anti-CMV activity (CMV lacks thymidine kinase for adequate acyclovir phosphorylation). Foscarnet is an alternative for ganciclovir-resistant CMV. Valacyclovir is not CMV prophylaxis in HIV-infected patients at standard doses.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.