Cytomegalovirus retinitis in Myanmar: valganciclovir and introcular injections of Ganciclovir in a resource-limited setting

MSF started its HIV project in Dawei, Myanmar in 2004 and is currently following nearly 4000 HIV-infected patients. Systematic CMV retinitis screening using indirect ophthalmoscopy was initiated in February 2013. Patients with diagnosed CMV retinitis were treated with intraocular ganciclovir injections until oral valganciclovir was available in February 2014.Myanmar has a concentrated HIV epidemic in a population of nearly 50 million people. HIV prevalence is 0.5% and an estimated 200,000 people are living with HIV. With the recent scaling up of ART in country, there are 67,000 patients on ART. Screening and treatment of CMV retinitis is not part of the routine management of HIV in Myanmar and not part of the national protocol. CMV retinitis screening was started in 2006 in some MSF HIV projects with HIV clinicians trained by consultant ophthalmologist. Diagnosed CMV retinitis patients were treated with intraocular ganciclovir injection. Valganciclovir treatment was introduced in February 2014.