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

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 ORCID: https://orcid.org/0000-0002-9615-1588, 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:	24 Oct 2019 08:20
URI:	https://archive.lstmed.ac.uk/id/eprint/9623

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