Minimizing fungal disease deaths will allow the UNAIDS target of reducing annual AIDS deaths below 500 000 by 2020 to be realized

Deaths from AIDS (1 500 000 in 2013) have been falling more slowly than
anticipated with improved access to antiretroviral therapy. Opportunistic
infections account for most AIDS-related mortality, with a median age of
death in the mid-30s. About 360 000 (24%) of AIDS deaths are attributed to
tuberculosis. Fungal infections deaths in AIDS were estimated at more than
700 000 deaths (47%) annually. Rapid diagnostic tools and antifungal agents
are available for these diseases and would likely have a major impact in reducing
deaths. Scenarios for reduction of avoidable deaths were constructed
based on published outcomes of the real-life impact of diagnostics and generic
antifungal drugs to 2020. Annual deaths could fall for cryptococcal disease by
70 000, Pneumocystis pneumonia by 162 500, disseminated histoplasmosis
by 48 000 and chronic pulmonary aspergillosis by 33 500, with approximately
60% coverage of diagnostics and antifungal agents; a total of .1 000 000 lives
saved over 5 years. If factored in with the 90–90–90 campaign rollout and its
effect, AIDS deaths could fall to 426 000 annually by 2020, with further
reductions possible with increased coverage. Action could and should be
taken by donors, national and international public health agencies, NGOs
and governments to achieve the UNAIDS mortality reduction target, by scaling
up capability to detect and treat fungal disease in AIDS.
This article is part of the themed issue ‘Tackling emerging fungal threats
to animal health, food security and ecosystem resilience’.