CMV retinitis in China and SE Asia: the way forward

Hdl Handle:
http://hdl.handle.net/10144/213250
Title:
CMV retinitis in China and SE Asia: the way forward
Authors:
Heiden, David; Saranchuk, Peter
Journal:
BMC Infectious Diseases
Abstract:
AIDS-related CMV retinitis is a common clinical problem in patients with advanced HIV/AIDS in China and Southeast Asia. The disease is causing blindness, and current clinical management, commonly characterized by delayed diagnosis and inadequate treatment, results in poor clinical outcomes: 21% - 36% of eyes with CMV retinitis are already blind at the time the diagnosis is first established by an ophthalmologist. CMV retinitis also identifies a group of patients at extraordinary risk of mortality, and the direct or indirect contribution of extraocular CMV disease to AIDS-related morbidity and mortality is currently unmeasured and clinically often overlooked. The obvious way to improve clinical management of CMV retinitis is to screen all patients with CD4 counts < 100 cells/μL with indirect ophthalmoscopy at the time they first present for care, and to provide systemic treatment with oral valganciclovir when active CMV retinitis is detected. Treatment of opportunistic infections is an integral part of HIV management, and, with appropriate training and support, CMV retinitis screening and treatment can be managed by the HIV clinicians, like all other opportunistic infections. Access to ophthalmologist has been problematic for HIV patients in China, and although non-ophthalmologists can perform screening, sophisticated ophthalmological skills are required for the management of retinal detachment and immune recovery uveitis, the major complications of CMV retinitis. CMV retinitis has been clinically ignored, in part, because of the perceived complexity and expense of treatment, and this obstacle can be removed by making valganciclovir affordable and widely available. Valganciclovir is an essential drug for developing successful programs for management of CMV retinitis in China and throughout SE Asia.
Affiliation:
Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA; Seva Foundation, Berkeley, CA, USA; South African Medical Unit, Operational Centre Brussels, Medicines Sans Frontieres, Cape Town, South Africa
Publisher:
BioMed Central
Issue Date:
24-Nov-2011
URI:
http://hdl.handle.net/10144/213250
DOI:
10.1186/1471-2334-11-327
Additional Links:
http://www.biomedcentral.com/1471-2334/11/327
Type:
Article
Language:
en
ISSN:
1471-2334
Appears in Collections:
Other Diseases

Full metadata record

DC FieldValue Language
dc.contributor.authorHeiden, Daviden
dc.contributor.authorSaranchuk, Peteren
dc.date.accessioned2012-02-28T06:21:33Z-
dc.date.available2012-02-28T06:21:33Z-
dc.date.issued2011-11-24-
dc.identifier.citationBMC Infectious Diseases 2011; 11:327en
dc.identifier.issn1471-2334-
dc.identifier.doi10.1186/1471-2334-11-327-
dc.identifier.urihttp://hdl.handle.net/10144/213250-
dc.description.abstractAIDS-related CMV retinitis is a common clinical problem in patients with advanced HIV/AIDS in China and Southeast Asia. The disease is causing blindness, and current clinical management, commonly characterized by delayed diagnosis and inadequate treatment, results in poor clinical outcomes: 21% - 36% of eyes with CMV retinitis are already blind at the time the diagnosis is first established by an ophthalmologist. CMV retinitis also identifies a group of patients at extraordinary risk of mortality, and the direct or indirect contribution of extraocular CMV disease to AIDS-related morbidity and mortality is currently unmeasured and clinically often overlooked. The obvious way to improve clinical management of CMV retinitis is to screen all patients with CD4 counts < 100 cells/μL with indirect ophthalmoscopy at the time they first present for care, and to provide systemic treatment with oral valganciclovir when active CMV retinitis is detected. Treatment of opportunistic infections is an integral part of HIV management, and, with appropriate training and support, CMV retinitis screening and treatment can be managed by the HIV clinicians, like all other opportunistic infections. Access to ophthalmologist has been problematic for HIV patients in China, and although non-ophthalmologists can perform screening, sophisticated ophthalmological skills are required for the management of retinal detachment and immune recovery uveitis, the major complications of CMV retinitis. CMV retinitis has been clinically ignored, in part, because of the perceived complexity and expense of treatment, and this obstacle can be removed by making valganciclovir affordable and widely available. Valganciclovir is an essential drug for developing successful programs for management of CMV retinitis in China and throughout SE Asia.en
dc.language.isoenen
dc.publisherBioMed Centralen
dc.relation.urlhttp://www.biomedcentral.com/1471-2334/11/327en
dc.rightsArchived with thanks to BMC Infectious Diseasesen
dc.subject.meshCytomegalovirus retinitisen
dc.subject.meshEye diseasesen
dc.titleCMV retinitis in China and SE Asia: the way forwarden
dc.typeArticleen
dc.contributor.departmentDepartment of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA; Seva Foundation, Berkeley, CA, USA; South African Medical Unit, Operational Centre Brussels, Medicines Sans Frontieres, Cape Town, South Africaen
dc.identifier.journalBMC Infectious Diseasesen
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