Roche Should Reduce Cost Of Oral Antibiotic To Prevent Blindness Among People With HIV/AIDS

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

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

Roche said that compared with costs in developed countries, it offers Valcytein developing countries at the lowest possible cost for long-term provision andon the same terms as its antiretroviral drugs, Reuters reports. Rochehas offered to provide aid agencies with Valcyte at a reduced cost of $1,900for a four-month course, but MSF said the price is too high and excludes manycountries where the problem is most widespread. The cost of the drug has forcedMSF into "tough compromises," Reuters reports. The groupuses treatment options in Thailandthat include intravenous treatment or injecting drugs directly into the eyes. MSFpays 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 patientsin developed countries, Roche said. "For this reason, Roche has to ensureits long-term commitments for transplant patients globally whilst helping toincrease access to Valcyte for AIDS patients in the poorest countries of theworld," Roche spokesperson Martina Rupp said, adding, "Based upon thenot insignificant patient need and the fact that treatment duration cannotnecessarily 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 statementsaid, "This is a classic case of the vicious circle." He added thatbecause the "price of the drug is so high, HIV programs aren't screeningand therefore are not reporting large numbers of CMV patients. But since onpaper there are so few patients, bringing down the price of this treatment andensuring its availability has never been a priority" (MSF release, 11/30).There is an "urgent need for Roche to both extend their discounted pricesto all developing countries and to lower this price further," MSF said (Reuters,12/3).

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CMV Retinitis ScreeningShould Be Included in Routine HIV/AIDS Care, Study Says

In related news, screeningfor CMV retinitis should be incorporated into routine HIV/AIDS care indeveloping countries, according to a study published in the Dec. 1 issue of PLoSMedicine, SciDev.net reports. For the study, DavidHeiden, an ophthalmologist at the CaliforniaPacific Medical Center, and colleagues examined retinal screening of 325 people with AIDS whoattended MSF clinics in Cambodia,Myanmar, South Africa, Thailandand Uganda.They found 20% of patients had CMV retinitis, and additional studies showedthat 37% of individual eyes were blind because of the disease. Health care forHIV/AIDS in developing countries rarely includes routine screening for thedisease, which can remain latent or be triggered by factors such as HIV.

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

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

Reprinted with permission from kaisernetwork.org. You can view theentire Kaiser DailyHIV/AIDS Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily HIV/AIDS Report ispublished for kaisernetwork.org, a free service of The Henry J. Kaiser FamilyFoundation.

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