AEGiS-Bangkok Post: Blindness in Aids patients not being diagnosed: MSF says drugs are too expensive

Important note: Information in this article was accurate in 2007. The state of the art may have changed since the publication date.

Blindness in Aids patients not being diagnosed: MSF says drugs are too expensive

Bangkok Post - December 2, 2007
Achara Ashayagachat

Blindness in HIV/Aids patients in Thailand, Burma and Cambodia is linked to a failure to diagnose and treat cytomegalovirus retinitis (CMV), according to a recent study published in the journal PLoS Medicine yesterday. The Doctors Without Borders (MSF) have studied CMV retinitis, which has been dramatically reduced in wealthy countries since the advent of antiretroviral therapy, but still found in many patients with advanced Aids in Cambodia, Burma and Thailand with 23%, 27% and 32% of the total cases respectively.

"We can diagnose CMV retinitis fairly easily and reliably in less than two minutes, and there is an effective, practical treatment, if at least the CMV retinitis is mentioned in the current and pending WHO guidelines for HIV treatment in resource-poor settings, and if Roche kindly reduce more the price for the package," said one of the authors, Dr David Wilson, a former MSF medical coordinator in Thailand.

The study, which is based on the clinical experience of Medecins Sans Frontieres and other programmes assessed by Dr David Heiden, a consultant from the SEVA Foundation in San Francisco, said 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.

But because there are often no symptoms in the early stages of the disease, CMV can only be diagnosed through the systematic screening of all at-risk patients.

Routine retinal examination of high-risk HIV patients in Burma helped save patients from CMV-related blindness, Dr Kalpana Sabapathy, an MSF HIV/Aids adviser, said. But in many countries the best treatment option is oral valganciclovir, which costs more than US$10,000 (about 308,000 baht) for a four-month treatment course, too much for people in developing countries.

"Until then, CMV retinitis will continue to be the neglected disease of the Aids epidemic," said Dr Tido von Schoen-Angerer, the director of MSF's Campaign for Access to Essential Medicines.

In Thailand, MSF and its local partners have decided to use the sub-optimal intravenous formulation of ganciclovir as well as intraocular injections.

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