Treatment of Serious Cytomegalovirus Infections With 9-(1,3-dihydroxy-2-propoxymethyl)guanine in Patients With AIDS and Other Immunodeficiencies

N Engl J Med. 1986 Mar 27;314(13):801-5. doi: 10.1056/NEJM198603273141301.

Abstract

The drug 9-(1,3-dihydroxy-2-propoxymethyl)-guanine (DHPG) was used to treat serious cytomegalovirus infections in 26 patients with underlying immunodeficiency (including 22 with the acquired immunodeficiency syndrome). In 17 of 22 patients in whom cytomegalovirus was virologically confirmed, clinical status improved or stabilized, although in 4 of them the status of some affected organs deteriorated or did not improve. Fourteen of 18 patients with adequate viral-culture data had clearing of cytomegalovirus from all cultured sites. Patients with cytomegalovirus pneumonia often responded poorly; four of seven died before completing 14 days of DHPG therapy. The condition of 11 of 13 patients with cytomegalovirus retinitis and 5 of 8 with gastrointestinal disease stabilized or improved. However, clinical and virologic relapses occurred in 11 of 14 patients (79 percent) when DHPG was discontinued. Neutropenia was the most frequent adverse reaction. We conclude that DHPG offers promise for the therapy of severe cytomegalovirus infections in some immunodeficient patients, but further study will be necessary to establish its efficacy and safety.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acquired Immunodeficiency Syndrome / complications*
  • Acyclovir / adverse effects
  • Acyclovir / analogs & derivatives*
  • Acyclovir / therapeutic use
  • Adult
  • Antiviral Agents / adverse effects
  • Antiviral Agents / therapeutic use*
  • Child, Preschool
  • Cytomegalovirus / isolation & purification
  • Cytomegalovirus Infections / drug therapy*
  • Cytomegalovirus Infections / microbiology
  • Drug Evaluation
  • Female
  • Ganciclovir* / analogs & derivatives*
  • Gastrointestinal Diseases / drug therapy
  • Humans
  • Immune Tolerance*
  • Immunologic Deficiency Syndromes / complications*
  • Infant
  • Male
  • Middle Aged
  • Pneumonia, Viral / drug therapy
  • Recurrence
  • Retinitis / drug therapy

Substances

  • Antiviral Agents
  • 9-((2,3-dihydroxy-1-propoxy)methyl)guanine
  • Ganciclovir
  • Acyclovir