1 / 24

Peter Saranchuk, MD TB-HIV Adviser Southern Africa Medical Unit (SAMU)

Scaling Up Retinal Screening in an HIV clinic in Nanning, China to prevent blindness from CMV retinitis . Peter Saranchuk, MD TB-HIV Adviser Southern Africa Medical Unit (SAMU) Operational Centre Brussels (OCB) Médecins Sans Frontières (MSF). Advances and Opportunities to

woods
Download Presentation

Peter Saranchuk, MD TB-HIV Adviser Southern Africa Medical Unit (SAMU)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Scaling Up Retinal Screeningin an HIV clinic in Nanning, Chinato prevent blindness from CMV retinitis Peter Saranchuk, MD TB-HIV Adviser Southern Africa Medical Unit (SAMU) Operational Centre Brussels (OCB) Médecins Sans Frontières (MSF) Advances and Opportunities to Address CMV retinitis Satellite Symposium IAS Conference 30 June 2013

  2. HIV late presenters 31.8% Of people present for the first time with a CD4 count < 200 cells/µL

  3. CMV: The 3rd most common/serious OI

  4. Prior to Nov 2008 in Nanning Problem: Diagnosis of CMV usually delayed • Retinal screening not done • Diagnosis made only after vision loss had already occurred • Irreversible • Required referral to a secondary hospital

  5. Poor Outcomes(prior to Nov 2008) • Of 17 patients assessed in Nov 2008 and found to have active or inactive CMV retinitis: • 5 (29%) had bilateral involvement • 7/11 eyes (64%) with inactive disease were blind* • * <20/400 visual acuity and/or able to count fingers at 10 feet

  6. Solution

  7. Training in retinal examination • Over 4days • By an ophthalmologist (D. Heiden) • Of HIV clinicians • In the use of an indirect ophthalmoscope (IO) • E-mail address given for follow-up support

  8. Ophthalmoscopy Indirect Vs. Direct The key to both = use dilating drops

  9. After Nov 2008 in Nanning • Retinal screening • Performed routinely • In all at-risk patients (e.g. those with CD4<100) • By HIV clinicians • Using an indirect ophthalmoscope • In the HIV clinic

  10. CMV retinitis has a typical pattern

  11. After Nov 2008 • Now able to diagnose CMV retinitis: • At the first visit • Within minutes • Inexpensively • At primary HIV care level • More easily than other common, serious OIs!

  12. After Nov 2008 • Now able to diagnose CMV retinitis: • At the first visit • Within minutes • Inexpensively • At primary HIV care level • More easily than other common, serious OIs! • = A point-of-care diagnostic!

  13. Every HIV clinic should have… • A bottle of drops to dilate pupils • E.g. Tropicamide

  14. Ophthalmologists still involved • Telemedicine • E-mailing of digital retinal images • Complicated cases • Immune Recovery Uveitis (I.e. IRIS) • Retinal detachment

  15. After Nov 2008 • Routine retinal screening •  Earlier diagnosis •  Earlier treatment •  Improved visual outcomes • E.g. Minority of patients now being diagnosed with CMV retinitis are blind

  16. Subsequent Trainings

  17. Average duration of treatment in Nanning ~4.5 months N.B.: ART needs to be initiated as soon as possible

  18. Usual Treatment: Sticking needles into eyes!

  19. Price of valganciclovir needs to be… <1 dollar per tablet to prevent CMV-related blindness and encourage retinal screening

  20. Conclusions • Retinal screening performed routinely prevents CMV-related blindness • Can be done by trained HIV clinicians • In resource-limited settings • Diagnosis of CMV retinitis then becomes easier than other OIs! • Need a treatment which is both convenient and affordable

  21. Acknowledgments • Dr. David Heiden • Pacific Vision Foundation • Seva Foundation • Chinese partners • Guangxi CDC • The Fourth Hospital of Nanning

  22. Treatment options in Nanning • Intravitreal injections (weekly) • Inexpensive • Barbaric! • I.v. ganciclovir (daily) • Expensive • Inpatient vs. outpatient? • Oral valganciclovir (VG) • Convenient • Outrageously expensive (~40 USD per tablet)

More Related