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Experience on Management of CMV Retinitis Medécins Sans Frontiéres

Experience on Management of CMV Retinitis Medécins Sans Frontiéres. Khin Nyein Chan Medical Coordinator, MSF. HIV program in Myanmar. MSF HIV/ART program started since 2003 17 TB/HIV clinics Yangon Region Taninthayi Region Kachin State Shan State Rakhine State

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Experience on Management of CMV Retinitis Medécins Sans Frontiéres

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  1. Experience on Management of CMV Retinitis Medécins Sans Frontiéres KhinNyein ChanMedical Coordinator, MSF

  2. HIV program in Myanmar • MSF HIV/ART program started since 2003 • 17 TB/HIV clinics • Yangon Region • Taninthayi Region • Kachin State • Shan State • Rakhine State • >30,000 patients are on HAART Moe Gaung Waing Maw

  3. What is CMV? • Cytomegalovirus (CMV) • >90% of people are sero+ for CMV in most developing countries • In immunocompromised host – re-activate • In AIDS patients, retina is the most common site of disease • Accounts for >90% of HIV related blindness • In RLS, CMV retinitis is the only clinical manifestation of the disease that we can diagnose.

  4. MSF Clinic in Myanmar 4

  5. CMV Management 34 yrs old male patient from KyonePyaw, Delta region (4-5 hrs drive one way) CD4 count 7 cells/mm3 and diagnosed with active CMV Retinitis (Lt eye) Treated with Intraocular injection of Gancyclovir and ART. CMV inactive after 5 consecutive weekly injections and currently under maintenance injection*. * Maintenance 2 weeksx2, every 3 weeksx2, every 4 weeks (until the retinitis is completely inactive AND CD4 count >100 cell/ul and checked on > 3 month HAART) 5

  6. Management of CMV Retinitis • Started in 2006 – Clinic MD receive the training from Dr. David Heiden* • *Consultant in uveitis, Department of Ophthalmology and Pacific Vision Foundation, California Pacific Medical Center, San Francisco, California

  7. Management of CMV Retinitis • Criteria for screening • CD4 count <100/mm3 • Eye complaints that relate to “vision” • Any patient with ophthalmic herpes zoster (ASAP) • Re screen 3 monthly as long as CD4 count is <100/mm3 • Number screened in Kachin and Yangon (2011-2012) – 4069 • Number treated of those screened (2011-2012) – 335

  8. Management of CMV Retinitis • It is possible to prevent blindness due to CMV retinitis in HIV patients by primary care HIV clinicians where ophthalmologists are not available!

  9. Challenges • Providing treatment to very sick people n = 24,008 Baseline Median CD4 of 15+ years, ARV naïve patients Cd4 precision 60 days 9

  10. Challenges (cont.) 2011 HIV-Cohort survey on “Origin of HIV patients registered” patient origins One dot represents “10” patients

  11. Challenges (cont.) • Management of Pediatric patients • Human Resource • After being trained, it takes another 3-6 months practice to become highly proficient on CMV retinitis management • Turnover of CMV experienced staff … • Interrupted program implementation • Not just the eyes!!! 11

  12. Way forward… • Continue prevention of blindness despite the challenges as this is the only option currently in the country • Looking forward to the accessible simpler diagnosis and affordable simple pills….. 12

  13. Thank you 13

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