Primary prophylaxis
All HIV infected children with severe immunosuppression (CD 4 count < 50 cells/cumm) may be considered for primary prophylaxis against CMV. However it is not routinely recommended.
Secondary prophylaxis
Life-long maintenance therapy following treatment for CMV disease is recommended. Maintenance therapy may be discontinued in patients on HAART who have an increase in CD 4 count to > 100-150 cells/cumm after 6 months of therapy. All patients who have had maintenance therapy discontinued should undergo 6 monthly ophthalmologic evaluation for evidence of chorioretinitis.
Drugs that can be used
|
Drug
|
Dosage
|
Adverse Effects
|
Remarks
|
|
Oral ganciclovir
|
30 mg/kg PO TID
|
Neutropenia, Myelosuppression, Renal toxicity, CNS effects, GI dysfunction, thrombophlebitis and elevated liver enzymes
|
Drug of choice
|
|
Oral valganciclovir
|
250 mg/m2/day PO OD
|
Myelosuppression
|
Data in children is lacking
|