"The particular form of blindness caused by CMV is absolute, total blindness.. everything is totally, totally black"
Dr David Wilson, former medical co-ordinator for MSF in Thailand. Read his interview
Many patients with advanced HIV/AIDS living in Southeast Asia fall prey to the infection, Cytomegalovirus (CMV) which can, if untreated, lead to total blindess in a very short space of time.
Blindness caused by CMV, a member of the herpes virus family, can be prevented, but the treatments are invasive - either by injection directly into the affected eye or taken intravenously, twice a day for three weeks and then daily infusions for another two or three months.
There is a better treatment available, produced by the pharmaceutical company, Hoffman-La-Roche. Valgancyclovir has the advantage that it can be taken in pill form once a day.
But at cost of US$10 000 in Thailand for a four month supply, this treatment is completely out of reach for some of the people most at risk of going blind.
"After my first injection... when I left the clinic the wind was blowing very hard and my eyes felt as if they were going to explode. I just could not hold my tears. I kept having pain for the whole week and before the pain was gone, I had to receive another injection" Dou, a CMV patient from XiangFan in Central China.
Read more
MSF calls on Roche to drop prices
MSF negotiated with Roche to bring down its price for oral Valgancyclovir. In December 2006, the company offered to bring the price down to 1899 US$ per course of treatment but only under very restrictive conditions:
- The drugs are only available at the reduced price to certain categories of developing countries – largely in Africa – thereby excluding patients in places like Thailand and China where the highest incidence of CMV has been monitored so far:
- The drugs are available only to NGOs and not to national treatment programmes:
- The drugs must be bought through the company's headquarters in Switzerland which throws up a number of difficulties makes it organisations wishing to purchase the drug that do not have branches in Europe.
MSF has set a target price of US $500 At the end of 2007, we went back to the company to request further discussions but so far Roche has said it will not negotiate further on price.
Monopoly position shuts out more affordable treatments.
The pro-drug valgancyclovir manufactured by Roche is patented in China and India. This means that Roche enjoys a monopoly position on the drug which will last until the patent expires in 2015. Until then, there can be no competition in those countries from generic companies to drive down the price of this medication. Meanwhile many more will be denied the best treatment that could save their sight .
Lives blighted by loss of sight
The loss of sight, while dreadful enough in itself, often has drastic consequences for people in developing countries who are then unable to work and have to live in total dependency with their families.
"I had one patient - a 23 year-old woman who has to be led everywhere now by her partner since she went blind. It's really awful to see young people in their twenties lose their sight. China is not an easy place for blind people and it's even worse to be blind and HIV positive.." Dr Karen Kiang, Medical Director at MSF's HIV/AIDS project in Nanning.
Read more
The full extent of CMV infection is not clearly known. But a paper published by the Public Library of Science sets out the possible scale of the problem and calls for more systematic diagnosis as well as better access to affordable and effective treatment for all patients as an essential part of HIV primary care.