[Ip-health] People in Southeast Asia Needlessly Becoming Blind Due to a Neglected Virus

Mon Dec 3 12:53:01 2007

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               People in Southeast Asia Needlessly Becoming=0D
                      Blind Due to a Neglected Virus=0D
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Geneva, 1st December 2007 =E2=80=93 Failure to diagnose and treat cytomegal=
ovirus=0D
retinitis (CMV) in people with AIDS is leading to unnecessary blindness,=0D
according to a paper published today in the journal PLoS Medicine. The=0D
authors found in pilot studies that CMV retinitis, which has been=0D
dramatically reduced in wealthy countries since the advent of=0D
antiretroviral therapy, occurred in 23, 27 and 32% of patients with=0D
advanced AIDS in Cambodia, Myanmar and Thailand respectively. By training=
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clinicians to screen and taking steps to make the best treatment=0D
affordable, the authors argue that CMV diagnosis and treatment can easily=
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be integrated into existing AIDS treatment programmes.=0D
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=E2=80=9CWe can diagnose CMV retinitis fairly easily and reliably in less t=
han two=0D
minutes, and there is an effective, practical treatment,=E2=80=9D said one =
of the=0D
authors, Dr. David Wilson, former MSF Medical Coordinator, Thailand.=0D
=E2=80=9CInstead of addressing the problem, it=E2=80=99s like the world is =
pretending the=0D
death and the blindness CMV causes are not happening, or worse, we=E2=80=99=
re just=0D
accepting them.=E2=80=9D=0D
=0D
Detecting and treating CMV retinitis early enough would stop the slow but=
=0D
relentless progress of a disease that leads to blindness within three to=0D
six months in patients whose immune systems are severely weakened with HIV.=
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But because there are often no symptoms in the early stage of the disease,=
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CMV can only be diagnosed through systematic screening of all at-risk=0D
patients.=0D
=0D
=E2=80=9CRoutine retinal examination of high-risk HIV patients in Myanmar h=
as=0D
allowed us to save patients from CMV-related blindness, =E2=80=9D said Dr. =
Kalpana=0D
Sabapathy, HIV/AIDS advisor at MSF, citing recent studies in the Myanmar=0D
programme by an ophthalmologist and CMV specialist from SEVA Foundation,=0D
Dr. David Heiden.=0D
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But in many countries the best treatment option, oral valganciclovir, costs=
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more than US$ 10,000 for a four-month treatment course.  An alternative=0D
treatment using intravenous ganciclovir is cumbersome, requiring infusions=
=0D
twice a day for two or three weeks, and then daily infusions for another=0D
two or three months.  A third method to treat CMV retinitis, with=0D
intraocular injections of ganciclovir - doctors have to repeatedly jab=0D
patients in one or both eyes - is all the more unsatisfactory.  This=0D
invasive technique requires special training and does nothing to treat=0D
potentially fatal forms of CMV that occur outside the eye.=0D
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Integration of CMV retinitis into HIV programmes is therefore feasible, but=
=0D
dependent on systematic screening of at-risk patients and securing access=
=0D
to affordable oral valganciclovir, the authors argue.  Until then, CMV=0D
retinitis will continue to be the neglected disease of the AIDS epidemic.=
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=0D
=E2=80=9CThis is a classic case of the vicious circle,=E2=80=9D said Dr. Ti=
do von=0D
Schoen-Angerer, Director of M=C3=A9decins Sans Fronti=C3=A8res=E2=80=99 Cam=
paign for Access=0D
to Essential Medicines. =E2=80=9CBecause the price of the drug is so high, =
HIV=0D
programmes aren=E2=80=99t screening and therefore are not reporting large n=
umbers=0D
of CMV patients. But since on paper there are so few patients, bringing=0D
down the price of this treatment and ensuring its availability has never=0D
been a priority.=E2=80=9D=0D
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CMV retinitis is not mentioned in the current and pending WHO guidelines=0D
for HIV treatment in resource-poor settings.=0D
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While there has been some progress on the accessibility of valganciclovir,=
=0D
it remains limited. NGOs have been proposed a discounted price from Roche=
=0D
of =E2=82=AC 1,281 (US$ 1,899) for a four-month course of therapy but this =
offer=0D
remains expensive and excludes many countries where the CMV retinitis=0D
problem is most acute.=0D
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This has forced difficult compromises. In Thailand, along with local=0D
partners, MSF has decided to use the sub-optimal intravenous formulation of=
=0D
ganciclovir as well as intraocular injections. In China, MSF pays the full=
=0D
price for oral valganciclovir, which is =E2=82=AC 6,930 (US$ 10,273). This =
is=0D
higher than the price of a Chinese economy car.=0D
=0D
There is an urgent need for Roche to both extend their discounted prices to=
=0D
all developing countries and to lower this price further. Current prices in=
=0D
China and Thailand mimic wealthy country prices where the drug is almost=0D
exclusively used to prevent CMV for patients undergoing organ transplants.=
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Roche is targeting a small but lucrative market, and protecting its=0D
position through patents, including in India, a significant source of=0D
generic drugs for developing countries.=0D
=0D
The PLoS paper was authored by an international team of eye doctors and HIV=
=0D
specialists and is based the clinical experience from M=C3=A9decins Sans=0D
Fronti=C3=A8res and other programmes assessed by the lead author, Dr. David=
=0D
Heiden, a consultant from SEVA Foundation, based at the California Pacific=
=0D
Medical Center, San Francisco.  The article Cytomegalovirus Retinitis: The=
=0D
Neglected Disease of the AIDS Pandemic is freely available from the open=0D
access journal PLoS Medicine at:=0D
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http://medicine.plosjournals.org/perlserv/?request=3Dget-document&doi=3D10.=
1371/journal.pmed.0040334=0D
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___________________________________________________________________________=
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For further information, please contact:=0D
Adrienne MacDonald, MSF Access Campaign, Geneva: +41 79 293 0270=0D
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+++++++++++++++++++++=0D
Adrienne MacDonald=0D
Communications Officer=0D
M=C3=A9decins Sans Fronti=C3=A8res=0D
Campaign for Access to Essential Medicines=0D
Rue de Lausanne 78=0D
1211 Geneva, Switzerland=0D
+ 41.22.849.8909=0D
+ 41.79.293.0270 (m.)=0D
www.accessmed-msf.org=0D
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