HOMEPRODUCTSCOMPANYCONTACTFAQResearchDictionaryPharmaSign Up FREE or Login

Leave no one behind: response to new evidence and guidelines for the management of cryptococcal meningitis in low-income and middle-income countries.

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.
AuthorsAngela Loyse, Jessica Burry, Jennifer Cohn, Nathan Ford, Tom Chiller, Isabela Ribeiro, Sinata Koulla-Shiro, Janneth Mghamba, Angela Ramadhani, Rose Nyirenda, Sani H Aliyu, Douglas Wilson, Thuy Le, Rita Oladele, Sokoine Lesikari, Conrad Muzoora, Newton Kalata, Elvis Temfack, Yacouba Mapoure, Victor Sini, Duncan Chanda, Meshack Shimwela, Shabir Lakhi, Jonathon Ngoma, Lilian Gondwe-Chunda, Chase Perfect, Amir Shroufi, Isabelle Andrieux-Meyer, Adrienne Chan, Charlotte Schutz, Mina Hosseinipour, Charles Van der Horst, Jeffrey D Klausner, David R Boulware, Robert Heyderman, David Lalloo, Jeremy Day, Joseph N Jarvis, Marcio Rodrigues, Shabbar Jaffar, David Denning, Chantal Migone, Megan Doherty, Olivier Lortholary, Françoise Dromer, Muirgen Stack, Síle F Molloy, Tihana Bicanic, Joep van Oosterhout, Peter Mwaba, Cecilia Kanyama, Charles Kouanfack, Sayoki Mfinanga, Nelesh Govender, Thomas S Harrison
JournalThe Lancet. Infectious diseases (Lancet Infect Dis) Vol. 19 Issue 4 Pg. e143-e147 (04 2019) ISSN: 1474-4457 [Electronic] United States
PMID30344084 (Publication Type: Journal Article, Review)
CopyrightCopyright © 2019 Elsevier Ltd. All rights reserved.
Chemical References
  • Antifungal Agents
  • Amphotericin B
  • Fluconazole
  • Flucytosine
Topics
  • Africa (epidemiology)
  • Amphotericin B (agonists, supply & distribution, therapeutic use)
  • Antifungal Agents (economics, supply & distribution, therapeutic use)
  • Coinfection
  • Cryptococcus neoformans (drug effects, pathogenicity)
  • Developing Countries
  • Disease Management
  • Drug Administration Schedule
  • Drug Therapy, Combination (economics, methods)
  • Fluconazole (economics, supply & distribution, therapeutic use)
  • Flucytosine (economics, supply & distribution, therapeutic use)
  • Guidelines as Topic
  • HIV Infections (mortality, pathology, virology)
  • Humans
  • Income
  • Meningitis, Cryptococcal (drug therapy, microbiology, mortality, pathology)
  • Survival Analysis

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research graph!


Choose Username:
Email:
Password:
Verify Password:
Enter Code Shown: