Table 1. Clinical and Laboratory Findings Associated with CMV Polyradiculopathy in Patients with AIDS*
|
CSF cell count, No./mm3 |
500 (0-1500)** |
|
Polymorphonuclear cells, % |
70 (40-95)** |
|
Protein, mg/dL |
275 (110-700)** |
|
Glucose, mg/dL |
30 (15-50)** |
|
CMV culture positive,% |
50 |
|
CMV PCR positive, % |
100 |
|
CMV at autopsy, % |
100 |
|
Acute denervation (electromyogram), % |
90 |
|
Small evoked M waves, % |
90 |
|
Progressive severe weakness, % |
100 |
|
Early sacral paresthesia, % |
100 |
|
Urinary retention, % |
80 |
|
CMV retinitis, % |
40 |
|
Sensory level, % |
20 |
|
Duration of illness, days |
30 (20-60)** |
* from reference 156.
**Approximate mean values with ranges.
Table 2. Usual Dosages of Antiviral Drugs for Treatment of CMV Infections in Adults and Children with Normal Renal Function. [Download PDF]
|
|
Route |
Adults |
|
|
Children |
|
|
Drug |
|
Induction |
Maintenance |
|
Induction |
Maintenance |
|
Ganciclovir |
IV |
5 mg/kg/dose Q12h |
5 mg/kg/dose once daily |
|
5 mg/kg/dose Q12h |
5 mg/kg/dose once daily |
|
Valganciclovir |
oral |
900 mg Q12h |
900 mg once daily |
|
Not studied in children |
|
|
Ganciclovir |
oral |
Not recommended |
1000 mg Q8h |
|
Not recommended |
30 mg/kg Q8h |
|
Foscarnet |
IV |
90 mg/kg/dose Q12h |
90 mg/kg Once daily |
|
90 mg/kg/dose Q12h |
90 mg/kg Once daily |
|
Cidofovir + Probenecid |
IV |
5 mg/kg once per week for 2 weeks (probenecid 2 grams must be given 3 hrs before dose, 1 gram at 4 and 10 hours post dose) |
5 mg/kg every 2 weeks (probenecid 2 grams must be given 3 hrs before dose, 1 gram at 4 and 10 hours post dose) |
|
Not studied in children |
|
|
Ganciclovir Implant |
intraocular |
N/A |
Replace every 7-8 months If necessary |
|
Not studied in children |
|
Table 3.
Ganciclovir Dose Modification in Renal Failure [Download
PDF]
|
IV Form* (Induction) |
Capsule Form (Valganciclovir) |
|
CrCl >70 mL/min 5 mg/kg q12h 50-69 mL/min ... 2.5 mg/kg q12h 25-49 mL/min 2.5 mg/kg q24h 10-24 mL/min ...1.25 mg/kg q24h <10 mL/min .1.25 mg 3 times/ week following hemodialysis |
CrCl > 70 mL/min ..1000 mg tid 50-69 mL/min . .1500 mg qd 500 mg tid 25-49 mL/min .1000 mg/day 500 mg/day bid 10-24 mL/min .500 mg qd <10 mL/min .500 mg 3 times/week post hemodialysis |
Maintenance dose is 50% of induction dose
|
CrCl (mL/min/kg) |
60 mg/kg dose (induction) |
90 mg/kg dose induction/maintenance |
120 mg/kg dose maintenance |
|
>1.4 >1.0-1.4 >0.8-1.0 >0.6-0.8 >0.5-0.6 >0.4-0.5 <0.4 |
60 q8h 45 q8h 50 q12h 40 q12h 60 q24h 50 q24h not recommended |
90 q12h 90 q24h 70 q12h 70 q24h 50 q12h 50 q24h 80 q24 80 q48h 60 q12h 60 q48h 50 q12h 50 q48h not recommended |
120 q24h 90 q24h 65 q24h 105 q48h 80 q48h 65 q48h not recommended |
Table 5. Characteristics of Viral Markers in Predicting CMV Disease in Organ Transplant Recipients [Download PDF]
|
Variable |
Antigenemia |
Plasma PCR |
Quantitative PBL* PCR |
bDNA |
pp67m RNA |
Hybrid capture CMV-DNA assay |
|
Sensitivity (%) |
95.2-100 |
55-100 |
91 |
100 |
64 |
87.5-100 |
|
Specificity (%) |
55.3-63.2 |
47-74 |
47 |
42.1 |
79 |
34-42 |
|
Positive predictive value (%) |
30-61.1 |
28-55 |
50 |
50 |
60 |
36-50 |
|
Negative predictive value (%) |
73-100 |
74-100 |
90 |
100 |
76 |
100 |
|
Time from positivity to onset of CMV Disease (days) |
9-18 |
6-21 |
10 |
9 |
0 |
12.5-14
|
*PBL = peripheral blood leukocyte
Table from (Singh, Liver Transplant 01)