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

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

Harrison, Thomas S

2020-08-03T22:51:34Z

2020-08-03T22:51:34Z

2019-04

2020-08-03T22:51:33Z

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.

S1473-3099(18)30493-6

1473-3099

1474-4457

https://hdl.handle.net/10161/21282

eng

Elsevier BV

The Lancet. Infectious Diseases

10.1016/s1473-3099(18)30493-6

Humans

Cryptococcus neoformans

Meningitis, Cryptococcal

HIV Infections

Amphotericin B

Fluconazole

Flucytosine

Antifungal Agents

Drug Therapy, Combination

Drug Administration Schedule

Survival Analysis

Developing Countries

Income

Disease Management

Africa

Guidelines as Topic

Coinfection

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

Journal article

Le, Thuy|0000-0002-3393-6580

e143

e147

4

School of Medicine

Molecular Genetics and Microbiology

Duke Global Health Institute

Medicine, Infectious Diseases

Duke

Basic Science Departments

University Institutes and Centers

Institutes and Provost's Academic Units

Medicine

Clinical Science Departments

Published

19