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Antimicrobial Agents and Chemotherapy, September 1998, p. 2240-2244, Vol. 42, No. 9
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Incidence of Foscarnet Resistance and Cidofovir Resistance in Patients Treated for Cytomegalovirus Retinitis

Douglas A. Jabs,1,2,* Cheryl Enger,3 Michael Forman,4 J. P. Dunn,1 for The Cytomegalovirus Retinitis, and Viral Resistance Study Group

Departments of Ophthalmology,1 Oncology,3 Pathology,4 and Medicine,2 The Johns Hopkins University School of Medicine, Baltimore, Maryland

Received 8 December 1997/Returned for modification 1 April 1998/Accepted 19 June 1998

Cytomegalovirus (CMV) retinitis is a common opportunistic infection in patients with AIDS. With long-term therapy for CMV retinitis, resistant CMV may develop. In a prospective study of 122 patients with CMV retinitis, 2.4 and 0.8% of patients had foscarnet-resistant blood culture isolates (50% inhibitory concentration [IC50], >400 µM) and urine culture isolates, respectively, at diagnosis of CMV retinitis prior to treatment, whereas 4.1 and 6.6% had cidofovir-resistant (IC50, >2 µM) blood and urine culture isolates, respectively. Patients were treated according to best medical judgement. Of 44 foscarnet-treated patients, 26% had a resistant blood or urine culture isolate by 6 months of treatment and 37% had a resistant isolate by 9 months; of 13 cidofovir-treated patients, 29% had a resistant blood or urine culture isolate by 3 months of therapy. The probabilities of developing foscarnet resistance while on foscarnet and developing cidofovir resistance while on cidofovir were not significantly different from that for developing ganciclovir resistance while on ganciclovir (odds ratios, 1.87 [P = 0.19] and 2.28 [P = 0.15], respectively).

* Corresponding author. Mailing address: The Wilmer Ophthalmological Institute, Suite 700, 550 N. Broadway, Baltimore, MD 21205. Phone: (410) 955-1966. Fax: (410) 955-0629. E-mail: dajabs{at}welchlink.welch.jhu.edu.

Antimicrobial Agents and Chemotherapy, September 1998, p. 2240-2244, Vol. 42, No. 9
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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