Refractory anti-viral resistant CMV retinitis in an immunological nonresponder person living with HIV.

Autor:	Serris A; Infectious Diseases Department, Bichat Claude-Bernard Hospital, AP-HP, université Paris cité, 46 rue Henri Huchard, 75018, Paris, France. Electronic address: alexandra.serris@aphp.fr., Rahi M; Infectious Diseases Department, Bichat Claude-Bernard Hospital, AP-HP, université Paris cité, 46 rue Henri Huchard, 75018, Paris, France., Rioux C; Infectious Diseases Department, Bichat Claude-Bernard Hospital, AP-HP, université Paris cité, 46 rue Henri Huchard, 75018, Paris, France., Fidouh N; Virology Department, Bichat Claude-Bernard Hospital, AP-HP, université Paris cité, Paris, France., Joly V; Infectious Diseases Department, Bichat Claude-Bernard Hospital, AP-HP, université Paris cité, 46 rue Henri Huchard, 75018, Paris, France., Boutolleau D; Virology Department, National Reference Centre for Herpesviruses, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, Paris, France; Sorbonne University, INSERM, Pierre Louis Institute of Epidemiology and Public Health (IPLESP), Paris, France.
Jazyk:	angličtina
Zdroj:	International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases [Int J Infect Dis] 2024 Nov; Vol. 148, pp. 107229. Date of Electronic Publication: 2024 Sep 01.
DOI:	10.1016/j.ijid.2024.107229
Abstrakt:	Cytomegalovirus (CMV) retinitis caused by drug-resistant viruses poses a major challenge in immunocompromised patients. We present the case of a patient living with HIV with persistently low CD4+ T cells count despite effective antiretroviral therapy, who experienced multiple episodes of CMV retinitis associated with iterative acquisition of resistance. The failure of ganciclovir and foscarnet treatments led us to implement a combined therapy of intravenous cidofovir, high-dose ganciclovir, and anti-CMV immunoglobulin as well as intravitreal injections of ganciclovir. This triple therapy was successful but resulted in significant myelotoxicity. Furthermore, the relapse of CMV retinitis and/or CMV viremia with each therapeutic de-escalation reflects the high level of immunodeficiency in our patient, despite sustained control of HIV viremia for several months. This case report highlights the need for a particular management of CMV infection in patients living with HIV who are immunological nonresponders. Competing Interests: Declarations of competing interest There is nothing to declare. (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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