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

Hdl Handle:
http://hdl.handle.net/10144/619321
Title:
Leave no one behind: response to new evidence and guidelines for the management of cryptococcal meningitis in low-income and middle-income countries
Authors:
Loyse, A; Burry, J; Cohn, J; Ford, N; Chiller, T; Ribeiro, I; Koulla-Shiro, S; Mghamba, J; Ramadhani, A; Nyirenda, R; Aliyu, SH; 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; Van der Horst, C; Klausner, JD; Boulware, DR; Heyderman, R; Lalloo, D; Day, J; Jarvis, JN; Rodrigues, M; Jaffar, S; Denning, D; Migone, C; Doherty, M; Lortholary, O; Dromer, F; Stack, M; Molloy, SF; Bicanic, T; van Oosterhout, J; Mwaba, P; Kanyama, C; Kouanfack, C; Mfinanga, S; Govender, N; Harrison, TS
Journal:
The Lancet. Infectious Diseases
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.
Publisher:
The Lancet
Issue Date:
18-Oct-2018
URI:
http://hdl.handle.net/10144/619321
DOI:
10.1016/S1473-3099(18)30493-6
PubMed ID:
30344084
Submitted date:
2018-12-13
Language:
en
ISSN:
1474-4457
Appears in Collections:
Other Diseases

Full metadata record

DC FieldValue Language
dc.contributor.authorLoyse, Aen
dc.contributor.authorBurry, Jen
dc.contributor.authorCohn, Jen
dc.contributor.authorFord, Nen
dc.contributor.authorChiller, Ten
dc.contributor.authorRibeiro, Ien
dc.contributor.authorKoulla-Shiro, Sen
dc.contributor.authorMghamba, Jen
dc.contributor.authorRamadhani, Aen
dc.contributor.authorNyirenda, Ren
dc.contributor.authorAliyu, SHen
dc.contributor.authorWilson, Den
dc.contributor.authorLe, Ten
dc.contributor.authorOladele, Ren
dc.contributor.authorLesikari, Sen
dc.contributor.authorMuzoora, Cen
dc.contributor.authorKalata, Nen
dc.contributor.authorTemfack, Een
dc.contributor.authorMapoure, Yen
dc.contributor.authorSini, Ven
dc.contributor.authorChanda, Den
dc.contributor.authorShimwela, Men
dc.contributor.authorLakhi, Sen
dc.contributor.authorNgoma, Jen
dc.contributor.authorGondwe-Chunda, Len
dc.contributor.authorPerfect, Cen
dc.contributor.authorShroufi, Aen
dc.contributor.authorAndrieux-Meyer, Ien
dc.contributor.authorChan, Aen
dc.contributor.authorSchutz, Cen
dc.contributor.authorHosseinipour, Men
dc.contributor.authorVan der Horst, Cen
dc.contributor.authorKlausner, JDen
dc.contributor.authorBoulware, DRen
dc.contributor.authorHeyderman, Ren
dc.contributor.authorLalloo, Den
dc.contributor.authorDay, Jen
dc.contributor.authorJarvis, JNen
dc.contributor.authorRodrigues, Men
dc.contributor.authorJaffar, Sen
dc.contributor.authorDenning, Den
dc.contributor.authorMigone, Cen
dc.contributor.authorDoherty, Men
dc.contributor.authorLortholary, Oen
dc.contributor.authorDromer, Fen
dc.contributor.authorStack, Men
dc.contributor.authorMolloy, SFen
dc.contributor.authorBicanic, Ten
dc.contributor.authorvan Oosterhout, Jen
dc.contributor.authorMwaba, Pen
dc.contributor.authorKanyama, Cen
dc.contributor.authorKouanfack, Cen
dc.contributor.authorMfinanga, Sen
dc.contributor.authorGovender, Nen
dc.contributor.authorHarrison, TSen
dc.date.accessioned2018-12-17T18:13:18Z-
dc.date.available2018-12-17T18:13:18Z-
dc.date.issued2018-10-18-
dc.date.submitted2018-12-13-
dc.identifier.citationLeave no one behind: response to new evidence and guidelines for the management of cryptococcal meningitis in low-income and middle-income countries. 2018 Lancet Infect Disen
dc.identifier.issn1474-4457-
dc.identifier.pmid30344084-
dc.identifier.doi10.1016/S1473-3099(18)30493-6-
dc.identifier.urihttp://hdl.handle.net/10144/619321-
dc.description.abstractIn 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.en
dc.language.isoenen
dc.publisherThe Lanceten
dc.rightsArchived with thanks to The Lancet. Infectious Diseasesen
dc.titleLeave no one behind: response to new evidence and guidelines for the management of cryptococcal meningitis in low-income and middle-income countriesen
dc.identifier.journalThe Lancet. Infectious Diseasesen

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