A 35-year-old woman with HIV (CD4 count 50 cells/µL) has progressive painless vision loss in the right eye. Fundoscopy shows 'pizza-pie' retinal haemorrhages and perivascular yellow-white exudates. Aqueous humor PCR is positive for CMV. What is the treatment of choice for CMV retinitis in this setting?
- A Oral acyclovir 800 mg 5 times daily × 14 days (high-dose acyclovir protocol)
- B Intravitreal ganciclovir PLUS systemic valganciclovir 900 mg BD × 21 days induction, then 900 mg daily maintenance, PLUS urgent antiretroviral therapy optimization ✓
- C IV foscarnet alone as first-line (ganciclovir is contraindicated in HIV)
- D Topical ganciclovir ophthalmic gel applied to the eye twice daily
Explanation
CMV retinitis treatment consists of induction therapy with either IV ganciclovir 5 mg/kg BD or oral valganciclovir 900 mg BD × 14–21 days (for non-sight-threatening lesions ≥1.5 mm from fovea, valganciclovir PO is equivalent to IV ganciclovir), followed by maintenance valganciclovir 900 mg OD until CD4 >100 cells/µL for ≥3 months on ART. For sight-threatening lesions close to fovea, intravitreal ganciclovir injection is added. Urgent ART optimisation is critical for immune reconstitution. Acyclovir has negligible anti-CMV activity at standard doses. Foscarnet is second-line (ganciclovir-resistant CMV).
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.