Abstract
In 2018, WHO issued guidelines for the diagnosis, prevention, and management of HIV-related cryptococcal disease. Two strategies are recommended to reduce the high mortality associated with HIV-related cryptococcal meningitis in low-income and middle-income countries (LMICs): optimised combination therapies for confirmed meningitis cases and cryptococcal antigen screening programmes for ambulatory people living with HIV who access care. WHO's preferred therapy for the treatment of HIV-related cryptococcal meningitis in LMICs is 1 week of amphotericin B plus flucytosine, and the alternative therapy is 2 weeks of fluconazole plus flucytosine. In the ACTA trial, 1-week (short course) amphotericin B plus flucytosine resulted in a 10-week mortality of 24% (95% CI -16 to 32) and 2 weeks of fluconazole and flucytosine resulted in a 10-week mortality of 35% (95% CI -29 to 41). However, with widely used fluconazole monotherapy, mortality because of HIV-related cryptococcal meningitis is approximately 70% in many African LMIC settings. Therefore, the potential to transform the management of HIV-related cryptococcal meningitis in resource-limited settings is substantial. Sustainable access to essential medicines, including flucytosine and amphotericin B, in LMICs is paramount and the focus of this Personal View.
Original language | English |
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Pages (from-to) | e143-e147 |
Number of pages | 5 |
Journal | The Lancet. Infectious diseases |
Volume | 19 |
Issue number | 4 |
DOIs | |
Publication status | Published - Apr 2019 |
Keywords
- Africa/epidemiology
- Amphotericin B/agonists
- Antifungal Agents/economics
- Coinfection
- Cryptococcus neoformans/drug effects
- Developing Countries
- Disease Management
- Drug Administration Schedule
- Drug Therapy, Combination/economics
- Fluconazole/economics
- Flucytosine/economics
- Guidelines as Topic
- HIV Infections/mortality
- Humans
- Income
- Meningitis, Cryptococcal/drug therapy
- Survival Analysis