MSF Calls On Roche To Reduce Cost Of Oral Antibiotic To Prevent Blindness Among People With HIV/AIDS In Developing Countries

Main Category: Eye Health / Blindness
Also Included In: HIV / AIDS
Article Date: 06 Dec 2007 - 12:00 PDT

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Medecins Sans Frontieres on Saturday called on pharmaceutical company Roche to provide its oral antibiotic valganciclovir at a reduced cost in developing countries to help prevent a virus that can cause blindness among people living with HIV/AIDS, Reuters reports.

Cytomegalovirus retinitis -- which can cause blindness within three to six months in people living with HIV/AIDS -- occurs in about 25% of people with advanced AIDS in developing countries -- such as Cambodia, Myanmar and China -- MSF said. The group said that CMV retinitis easily is diagnosed and that valganciclovir -- sold under the brand name Valcyte -- is an effective treatment. However, the drug is too costly for agencies to supply it to people living with the disease in developing countries, according to MSF.

Roche said that compared with costs in developed countries, it offers Valcyte in developing countries at the lowest possible cost for long-term provision and on the same terms as its antiretroviral drugs, Reuters reports. Roche has offered to provide aid agencies with Valcyte at a reduced cost of $1,900 for a four-month course, but MSF said the price is too high and excludes many countries where the problem is most widespread. The cost of the drug has forced MSF into "tough compromises," Reuters reports. The group uses treatment options in Thailand that include intravenous treatment or injecting drugs directly into the eyes. MSF pays more than $10,000 for a four-month course of Valcyte per patient in China.

Valcyte primarily is used to prevent CMV retinitis in organ transplant patients in developed countries, Roche said. "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 spokesperson Martina Rupp said, adding, "Based upon the not insignificant patient need and the fact that treatment duration cannot necessarily be assumed to be consistently short," the company considers "drug donations of Valcyte to be neither feasible or sustainable" (Cage, Reuters, 12/3).

Tido von Schoen-Angerer, head of MSF's essential medicines campaign, in a statement said, "This is a classic case of the vicious circle." He added that because the "price of the drug is so high, HIV programs 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" (MSF release, 11/30). 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 (Reuters, 12/3).

CMV Retinitis Screening Should Be Included in Routine HIV/AIDS Care, Study Says
In related news, screening for CMV retinitis should be incorporated into routine HIV/AIDS care in developing countries, according to a study published in the Dec. 1 issue of PLoS Medicine, SciDev.net reports. For the study, David Heiden, an ophthalmologist at the California Pacific Medical Center, and colleagues examined retinal screening of 325 people with AIDS who attended MSF clinics in Cambodia, Myanmar, South Africa, Thailand and Uganda. They found 20% of patients had CMV retinitis, and additional studies showed that 37% of individual eyes were blind because of the disease. Health care for HIV/AIDS in developing countries rarely includes routine screening for the disease, which can remain latent or be triggered by factors such as HIV.

The World Health Organization has not included CMV retinitis in its guidelines for management of HIV in developing countries or in its Vision 2020 blindness program, according to the authors. "CMV has been ignored in resource-poor settings, but must be in the list," Heiden said.

The initial step toward addressing CMV retinitis is to train health workers to use an indirect ophthalmoscope -- a fast, low-cost device that eliminates the need for special eye tests -- according to the study. The second step is treatment, the authors write, adding that although Valcyte is an "effective treatment" for CMV retinitis, it is a "single-source monopoly product priced at a level that is absurdly unrealistic. The medication needs to [be] made available and affordable" (Garcia/Pratchaya, SciDev.net, 12/3).

The study is available online.

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