Leave no one behind: response to new evidence and guidelines for the management of cryptococcal meningitis in low-income and middle-income countries. Loyse, A., Burry, J., Cohn, J., Ford, N., Chiller, T., Ribeiro, I., Koulla-Shiro, S., Mghamba, J., Ramadhani, A., Nyirenda, R., Aliyu, S. H, Wilson, D., Le, T., Oladele, R., Lesikari, S., Muzoora, C., Kalata, N., Temfack, E., Mapoure, Y., Sini, V., Chanda, D., Shimwela, M., Lakhi, S., Ngoma, J., Gondwe-Chunda, L., Perfect, C., Shroufi, A., Andrieux-Meyer, I., Chan, A., Schutz, C., Hosseinipour, M. C, Van der Horst, C., Klausner, J. D, Boulware, D. R, Heyderman, R., Lalloo, D., Day, J., Jarvis, J. N, Rodrigues, M., Jaffar, S., Denning, D., Migone, C., Doherty, M., Lortholary, O., Dromer, F., Stack, M., Molloy, S. F, Bicanic, T., van Oosterhout, J., Mwaba, P., Kanyama, C., Kouanfack, C., Mfinanga, S., Govender, N. P, & Harrison, T. S The Lancet Infectious Diseases, 19(4):e143–e147, oct, 2018. ![Leave no one behind: response to new evidence and guidelines for the management of cryptococcal meningitis in low-income and middle-income countries [link]](https://bibbase.org/img/filetypes/link.svg "link")
Paper doi abstract bibtex 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.
@article{Loyse2018,
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.},
author = {Loyse, Angela and Burry, Jessica and Cohn, Jennifer and Ford, Nathan and Chiller, Tom and Ribeiro, Isabela and Koulla-Shiro, Sinata and Mghamba, Janneth and Ramadhani, Angela and Nyirenda, Rose and Aliyu, Sani H and Wilson, Douglas and Le, Thuy and Oladele, Rita and Lesikari, Sokoine and Muzoora, Conrad and Kalata, Newton and Temfack, Elvis and Mapoure, Yacouba and Sini, Victor and Chanda, Duncan and Shimwela, Meshack and Lakhi, Shabir and Ngoma, Jonathon and Gondwe-Chunda, Lilian and Perfect, Chase and Shroufi, Amir and Andrieux-Meyer, Isabelle and Chan, Adrienne and Schutz, Charlotte and Hosseinipour, Mina C and {Van der Horst}, Charles and Klausner, Jeffrey D and Boulware, David R and Heyderman, Robert and Lalloo, David and Day, Jeremy and Jarvis, Joseph N and Rodrigues, Marcio and Jaffar, Shabbar and Denning, David and Migone, Chantal and Doherty, Megan and Lortholary, Olivier and Dromer, Fran{\c{c}}oise and Stack, Muirgen and Molloy, S{\'{i}}le F and Bicanic, Tihana and van Oosterhout, Joep and Mwaba, Peter and Kanyama, Cecilia and Kouanfack, Charles and Mfinanga, Sayoki and Govender, Nelesh P and Harrison, Thomas S},
doi = {10.1016/S1473-3099(18)30493-6},
issn = {14733099},
journal = {The Lancet Infectious Diseases},
keywords = {fund{\_}not{\_}ack,perspective},
mendeley-tags = {fund{\_}not{\_}ack,perspective},
month = {oct},
number = {4},
pages = {e143--e147},
pmid = {30344084},
title = {{Leave no one behind: response to new evidence and guidelines for the management of cryptococcal meningitis in low-income and middle-income countries}},
url = {http://www.ncbi.nlm.nih.gov/pubmed/30344084 https://linkinghub.elsevier.com/retrieve/pii/S1473309918304936},
volume = {19},
year = {2018}
}
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