Here is research done in Burma to show that cytomegalovirus retinitis is a neglected problem. This is not surprising since most people who present for care already have severe immunosuppression.
The [him] moderator can email you the paper if you ask [him].
[him] moderator
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Cytomegalovirus Retinitis: The Neglected Disease of the AIDS Pandemic
David Heiden*, Nathan Ford, David Wilson, William R. Rodriguez, Todd Margolis, Bart Janssens, Martha Bedelu, Nini Tun, Eric Goemaere, Peter Saranchuk, Kalpana Sabapathy, Frank Smithuis, Emmanuel Luyirika, W. Lawrence Drew
Summary Points
• In Western countries in the pre-HAART era, about 1/3 of patients with AIDS suffered potentially blinding CMV retinitis. Extraocular CMV infection in the CNS, gastrointestinal tract, and other organs contributed to AIDS-related mortality.
• In developing countries, CMV retinitis has been neglected, with little data describing the scope of the problem, and no strategy for management of the disease.
• Retinal screening examinations were conducted at the primary care level in AIDS clinics in five countries of sub-Saharan Africa and Southeast Asia in 325 patients with CD4 counts below 50 cells/μl. Twenty percent of patients had CMV retinitis, usually not previously diagnosed, and additional studies found 37% of individual eyes with CMV retinitis were blinded by the infection.
• Successful management of CMV retinitis is a realistic goal, and must begin with decentralizing diagnostic capacity to the primary care level. All high-risk patients (at minimum all patients with CD4 count below 50 cells/μl) must have retinal screening examination with the pupil fully dilated and using an indirect ophthalmoscope.
• Treatment with valganciclovir, an oral medication that is effective for both ocular and systemic disease, is essential. Valganciclovir, a single-source monopoly product, is prohibitively expensive at present, but must be made available and affordable.
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040334&ct=1&SESSID=5dc76093222be195d2b2f2fc0b2a1f97
