Everyday is a Foggy Day: CMV Infections affect life for AIDS Patients in China

Fog surrounded our car on all sides as we drove to see Dou, who lives in Ou Miao village, thirty-minute drive away from the MSF HIV clinic in Xiangfan City in Central China. The driver complained that the heavy mist made everything around us invisible. But we are lucky compared to Dou.

Since Dou contracted CMV retinitis, every day is as difficult as navigating a fog choked road. "I can see that there are two people standing in front of me," Dou told us when we first met her. "But I cannot see your faces; I cannot tell if you are male or female. I have to guess from your voices."

In fact, Dou  had to get a guard dog since she could no longer see people coming in and out of the house. And CMV has forced her to make many other changes in her life.

Like most women in her village, Dou used to be in charge of taking care of the household and working in the fields. However, now that she can no longer even see the dirt on her children's clothing to wash them, her husband has to do most of the housework.

She also cannot tell the difference between money notes of different value so she can no longer go out to buy things. Many women in the village play mahjong together under the sunshine in winter; Dou stays in her house with the doors closed

"In 2005, my vision began to get blurry, as my health became so poor." Dou's immunity levels because of her HIV infection had dropped dangerously low and she was critically ill. She felt discomfort in her eyes and they sometimes hurt her. In October 2006, she was diagnosed with CMV retinitis and put on treatment.

CMV infection can present in the eye as CMV retinitis, leading to a slow but relentless destruction of the retina in three to six months, with profound and irreversible blindness occurring much more quickly; or it may be extra-ocular (in the central nervous system, gastrointestinal tract, or other organs) and lead to death. Routine retinal examination with ophthalmoscope can effectively diagnose CMV retinitis

"Injecting into my eyeballs?" Panic was the first reaction of Dou, as she never heard of or imagined such a treatment.

But the viable option to treat CMV in Xiangfan is intraocular injections of ganciclovir - weekly injections directly into a patient’s eye for three months. It's possible to adminster the drug intravenously but it's a cumbersome and costly procedure

"The first time I got the injection, I could not even see the doctor as she put the needle in my eye...when I left the clinic the wind was blowing very hard and my eyes felt as if they were going to explode. I just could not hold my tears. I kept having pain for the whole week and before the pain was gone, I had to receive another injection."

Her doctor gave her some eye drops to ease the pain, but being treated for her illness through direct injections continued to be a struggle.

"Every week, I had to walk for an hour to catch the bus to Xiangfan. Sometimes, especially when it was raining, I would slip and fall on the dirt road many times. I would get upset and think of giving up"

Dou's husband is a skilled labourer at a construction site. During her three months of treatment, he took time off work to take care of her, giving up those months' salary. He even had to put less salt in the food in order to save some money.

Actually Dou could have taken a much easier treatment at home instead of struggling out to the hospital every week. Valganciclovir is an oral medication launched by the Roche Company in 2001, which is taken in pill form twice a day for the first three weeks, and then once a day for the remaining course of treatment.

However it is inaccessible in for people in Dou's situation due to its high price. As a middle income country, China is not eligible to receive the drug at a reduced price offered by the company, nor are there cheaper generic versions of the drug on the market.

Until more affordable options are available, the nearly 100,000 RMB price tag for these pills will prevent Dou and other CMV-infected HIV patients like her from benefitting from this drug and lifting the weight of a painful treatment from their already over-burdened shoulders.

Dou's vision improved slightly after receiving her injections. However, the treatment came a little too late and the damage to her eyes could not be reversed. While we look forward to a clearer sky for the next day, for Dou, tomorrow can only be another foggy day.

MSF working in Xianfan, central China,  to help patients with CMV

In collaboration with local health authorities, MSF set up a HIV clinic in Xiangfan, a city with over 2800-year history in Hubei Province in central China in May 2003. Comprehensive treatment and care has been offered to over 450 HIV patients, nearly half of them receiving anti-retroviral therapy.

Since August 2006, patients with CD4 lower than 50 (measure of suppressed immune system due to HIV) have been systematically screened for CMV retinitis. Patients with positive results have been given Intra-ocular Ganciclovir injections until their CD4 rises above 100. A total of 75 patients have been screened and 11 patients have received treatment.

This five-year programme is scheduled to be complete and handed over to local health authorities in March this year.