[e-drug] People in SE Asia Blind Due to a Neglected Virus

[Adrienne.MacDONALD@geneva.msf.org]

E-DRUG: People in SE Asia Blind Due to a Neglected Virus
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Geneva, 1st December 2007 'Failure to diagnose and treat cytomegalovirus
retinitis (CMV) in people with AIDS is leading to unnecessary blindness,
according to a paper published today in the journal PLoS Medicine. The
authors found in pilot studies that CMV retinitis, which has been
dramatically reduced in wealthy countries since the advent of
antiretroviral therapy, occurred in 23, 27 and 32% of patients with
advanced AIDS in Cambodia, Myanmar and Thailand respectively. By training
clinicians to screen and taking steps to make the best treatment
affordable, the authors argue that CMV diagnosis and treatment can easily
be integrated into existing AIDS treatment programmes.

'We can diagnose CMV retinitis fairly easily and reliably in less than two
minutes, and there is an effective, practical treatment,' said one of the
authors, Dr. David Wilson, former MSF Medical Coordinator, Thailand.
'Instead of addressing the problem, it's like the world is pretending the
death and the blindness CMV causes are not happening, or worse, we're just
accepting them.'

Detecting and treating CMV retinitis early enough would stop the slow but
relentless progress of a disease that leads to blindness within three to
six months in patients whose immune systems are severely weakened with HIV.
But because there are often no symptoms in the early stage of the disease,
CMV can only be diagnosed through systematic screening of all at-risk
patients.

'Routine retinal examination of high-risk HIV patients in Myanmar has
allowed us to save patients from CMV-related blindness,' said Dr. Kalpana
Sabapathy, HIV/AIDS advisor at MSF, citing recent studies in the Myanmar
programme by an ophthalmologist and CMV specialist from SEVA Foundation,
Dr. David Heiden.

But in many countries the best treatment option, oral valganciclovir, costs
more than US$ 10,000 for a four-month treatment course.  An alternative
treatment using intravenous ganciclovir is cumbersome, requiring infusions
twice a day for two or three weeks, and then daily infusions for another
two or three months.  A third method to treat CMV retinitis, with
intraocular injections of ganciclovir - doctors have to repeatedly jab
patients in one or both eyes - is all the more unsatisfactory.  This
invasive technique requires special training and does nothing to treat
potentially fatal forms of CMV that occur outside the eye.

Integration of CMV retinitis into HIV programmes is therefore feasible, but
dependent on systematic screening of at-risk patients and securing access
to affordable oral valganciclovir, the authors argue.  Until then, CMV
retinitis will continue to be the neglected disease of the AIDS epidemic.

'This is a classic case of the vicious circle,' said Dr. Tido von
Schoen-Angerer, Director of Medecins Sans Frontieres' Campaign for Access
to Essential Medicines. 'Because the price of the drug is so high, HIV
programmes aren't screening and therefore are not reporting large numbers
of CMV patients. But since on paper there are so few patients, bringing
down the price of this treatment and ensuring its availability has never
been a priority.'

CMV retinitis is not mentioned in the current and pending WHO guidelines
for HIV treatment in resource-poor settings.

While there has been some progress on the accessibility of valganciclovir,
it remains limited. NGOs have been proposed a discounted price from Roche
of 1,281 (US$ 1,899) for a four-month course of therapy but this offer
remains expensive and excludes many countries where the CMV retinitis
problem is most acute.

This has forced difficult compromises. In Thailand, along with local
partners, MSF has decided to use the sub-optimal intravenous formulation of
ganciclovir as well as intraocular injections. In China, MSF pays the full
price for oral valganciclovir, which is 6,930 (US$ 10,273). This is
higher than the price of a Chinese economy car.

There is an urgent need for Roche to both extend their discounted prices to
all developing countries and to lower this price further. Current prices in
China and Thailand mimic wealthy country prices where the drug is almost
exclusively used to prevent CMV for patients undergoing organ transplants.
Roche is targeting a small but lucrative market, and protecting its
position through patents, including in India, a significant source of
generic drugs for developing countries.

The PLoS paper was authored by an international team of eye doctors and HIV
specialists and is based the clinical experience from Medecins Sans
Frontieres and other programmes assessed by the lead author, Dr. David
Heiden, a consultant from SEVA Foundation, based at the California Pacific
Medical Center, San Francisco.  The article Cytomegalovirus Retinitis: The
Neglected Disease of the AIDS Pandemic is freely available from the open
access journal PLoS Medicine at:

http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040334
[repair link]
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For further information, please contact:
Adrienne MacDonald, MSF Access Campaign, Geneva: +41 79 293 0270

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Adrienne MacDonald
Communications Officer
Medecins Sans Frontieres
Campaign for Access to Essential Medicines
Rue de Lausanne 78
1211 Geneva, Switzerland
+ 41.22.849.8909
+ 41.79.293.0270 (m.)
www.accessmed-msf.org
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