Faded from memory in developed countries since the advent of antiretroviral treatment, and under-diagnosed in low- and middle-income countries where treatment has remained out of reach for many, cytomegalovirus retinitis, the disease that causes HIV-related blindness, has been called the neglected opportunistic infection of the AIDS pandemic. A recently released study suggests the scope of the disease’s continued prevalence, concluding it remains high in resource limited settings, particularly in Asian countries. But the study, looking at research across 24 countries, found that a tragic cycle keeps the disease from being adequately addressed, treated, or even recognized in places where the only affordable treatment has been painful repeated injections into patients’ eyes administered by trained health professionals, where health systems are overburdened and where diagnostic skills are limited. With little motivation to diagnose a disease for which treatment was inaccessible, screening has lagged, feeding the perception that an affordable drug to treat it was not urgently needed.
It is a cycle that researchers and treatment access advocates hope is soon to be broken by an agreement announced this week between the Medicines Patent Pool and Roche, the maker of the oral drug valganciclovir, which treats cytomegalovirus retinitis. The agreement, signed in July, will increase access to the drug in 138 countries by reducing its price up to 90 percent.
In addition to making treatment available to people who would otherwise lose their eyesight, the price reduction is hoped to lay a foundation for better learning the true prevalence of the disease, Kaitlin Mara of Medicines Patent Pool said. In addition, a more accurate assessment of the impact of that opportunistic infection will contribute to a better understanding of the true impact of delayed access to antiretroviral treatment for HIV, Mara said.
The cytomegalovirus burden study found that late HIV treatment contributed to the continued high prevalence of the disease in Asia, where an estimated one in five patients begin treatment with a dangerously diminished immune cell, or CD4, count of less than 100 cells per microliter of blood. The World Health Organization’s recently updated guidelines recommend antiretroviral treatment for people with HIV whose immune cell count has dropped to 500 or below. Prior to that the WHO recommended antiretroviral treatment initiation at an immune cell count of 350 or less.
The study, which was supported by the Medicines Patent Pool, Medecins Sans Frontier, the World Health Organization, and a number of other research organizations, cited research showing “that with effective antiretroviral therapy even people starting ART with a very low CD4 cell count can expect to live several decades, but quality of life will be severely compromised by loss of vision.”
The price reduction is a first step in what is hoped to be a series to improve screening and treatment of cytomegalovirus, Mara said. Other steps, she added, include country programs boosting diagnostic efforts, clinics strengthening training for diagnosing the disease, and public health programs spreading awareness of its impact.