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Emerging concepts in HIV-associated cryptococcal meningitis

David S Lawrence1,2, Timothée Boyer-Chammard3,4, Joseph N Jarvis1,2

  • 1Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.

Current Opinion in Infectious Diseases
|December 4, 2018
PubMed

Insights

HIV-associated cryptococcal meningitis is a major cause of AIDS mortality. New treatments and trials show promise in reducing deaths from this serious infection.

Area of Science:

  • Infectious Diseases
  • Neuroscience
  • Immunology

Background:

  • HIV-associated cryptococcal meningitis contributes significantly to AIDS-related mortality.
  • Despite advances in antiretroviral therapy, mortality rates remain high, around 40% in clinical trials.
  • Cryptococcal meningitis causes an estimated 181,100 deaths annually worldwide.

Purpose of the Study:

  • To review recent findings and ongoing clinical trials for HIV-associated cryptococcal meningitis.
  • To highlight advancements in optimizing induction therapy for this opportunistic infection.
  • To advocate for improved access to essential antifungal medications.

Main Methods:

  • Review of global burden of disease data.
  • Analysis of clinical trial outcomes and emerging treatment protocols.
  • Evaluation of antifungal treatment strategies, including amphotericin B, flucytosine, and fluconazole.

Main Results:

  • Screening for cryptococcal antigen and preemptive antifungal treatment can reduce incidence and mortality.
  • Shortening amphotericin B treatment to 7 days with flucytosine improves outcomes and reduces toxicity.
  • Flucytosine is a superior adjunct to amphotericin B compared to fluconazole.
  • Oral antifungal combinations of flucytosine and fluconazole offer an alternative treatment where amphotericin B is unavailable.
  • A single high-dose of liposomal amphotericin B is being evaluated for efficacy.

Conclusions:

  • Ongoing clinical trials are crucial for optimizing cryptococcal meningitis induction therapy.
  • Increased access to amphotericin formulations and flucytosine is essential.
  • Combined screening, preemptive treatment, and optimized therapy can reduce mortality from HIV-associated cryptococcal meningitis.
Abstract

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