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

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Loyse, Angela, Burry, Jessica, Cohn, Jennifer, Ford,, Nathan, Chiller, Tom, Ribeiro, Isabela, Koulla-Shiro, Sinata, Mghamba, Janneth, Ramadhani, Angela, Nyirenda, Rose, Aliyu, Sani H, Wilson, Douglas, Le, Thuy, Oladele, Rita, Lesikari, Sokoine, Muzoora, Conrad, Kalata, Newton, Temfack, Elvis, Mapoure, Yacouba, Sini, Victor, Chanda, Duncan, Shimwela, Meshack, Lakhi, Shabir, Ngoma, Jonathon, Gondwe-Chunda, Lilian, Perfect, Chase, Shroufi, Amir, Andrieux-Meyer, Isabelle, Chan, Adrienne, Schutz, Charlotte, Hosseinipour, Mina, Van der Horst, Charles, Klausner, Jeffrey D, Boulware, David R, Heyderman, Robert, Lalloo, David ORCID: https://orcid.org/0000-0001-7680-2200, Day, Jeremy, Jarvis, Joseph N, Rodrigues, Marcio, Jaffar, Shabbar, Denning, David, Migone, Chantal, Doherty, Megan, Lortholary, Olivier, Dromer, Françoise, Stack, Muirgen, Molloy, Síle F, Bicanic, Tihana, van Oosterhout, Joep, Mwaba, Peter, Kanyama, Cecilia, Kouanfack, Charles, Mfinanga, Sayoki, Govender, Nelesh and Harrison, Thomas S (2019) 'Leave no one behind: response to new evidence and guidelines for the management of cryptococcal meningitis in low-income and middle-income countries'. Lancet Infectious Diseases, Vol 19, Issue 4, e143-e147.

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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.

Item Type: Article
Subjects: QV Pharmacology > Anti-Inflammatory Agents. Anti-Infective Agents. Antineoplastic Agents > QV 252 Antifungal agents. Antifungal antibiotics
WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Mycoses > WC 475 Cryptococcosis. Sporotrichosis
WL Nervous System > WL 100 General works
WL Nervous System > WL 200 Meninges. Blood-brain barrier
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1016/S1473-3099(18)30493-6
Depositing User: Stacy Murtagh
Date Deposited: 15 Nov 2018 15:35
Last Modified: 18 Apr 2019 01:02
URI: http://archive.lstmed.ac.uk/id/eprint/9623

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