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

Reuters NewMedia - December 3, 2007
Sam Cage

Cytomegalovirus (CMV) retinitis, which can cause blindness in 3 to 6 months in patients whose immune systems are already severely weakened by HIV, occurs in about a quarter of patients with advanced AIDS in developing countries such as Cambodia and Myanmar, MSF said on Saturday.

The disease can be diagnosed quite easily and Valcyte is an effective treatment, but clinicians need better training and the oral drug is too expensive for humanitarian agencies to help many sufferers, MSF said.

Roche said it was offering Valcyte at a "significantly reduced price" to poorer countries compared to developed countries and the lowest it can supply long-term, on the same terms as its antiretroviral drugs.

"This is a classic case of the vicious circle," Dr Tido von Schoen-Angerer, head of MSF's essential medicines campaign, said in a statement. "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," von Schoen-Angerer said.

TOUGH COMPROMISES

Valcyte is primarily used to prevent CMV in organ transplant patients in richer countries.

"For this reason Roche has to ensure its long-term commitments for transplant patients globally whilst helping to increase access to Valcyte for AIDS patients in the poorest countries of the world," Roche spokeswoman Martina Rupp said.

"Based upon the not insignificant patient need and the fact that treatment duration cannot necessarily be assumed to be consistently short, means we consider drug donations of Valcyte to be neither feasible or sustainable," Rupp said.

While Roche has offered aid agencies a discounted price of $1,900 for a 4-month course of oral Valcyte -- also known by its generic name valganciclovir -- this is still too expensive and excludes many countries where the problem is most acute, including China, MSF said.

This has forced MSF into tough compromises. In Thailand it uses the more cumbersome treatment options, either intravenous or injected directly into the eyes. In China MSF pays full price of more than $10,000 per 4-month course per patient for Valcyte -- more than a Chinese economy car. -- more than 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," MSF said.

"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."

(Editing by Louise Ireland)

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