EIGHTEEN years ago I lost a brother,” recalled Dr. Christine Nabiryo. “He had severe headache before he died. Doctors diagnosed him with cryptococcal meningitis which comes with severe headache,” said Nabiryo, the deputy executive director of programmes and strategic information at The AIDS Support Organisation.
Then, in the 1990s, people living with HIV/AIDS had no drugs to fall back on. “You all know that when an HIV-positive person starts complaining of severe headache we all start counting days, thinking it is a death warrant,” she said.
Cryptococcal meningitis is the most common infection of the brain and spinal cord or the central nervous system in patients with advanced HIV infection, says Dr. Anatoli Kamali a clinical epidemiologist and head of the HIV prevention research programme of the Medical Research Council unit in Masaka.
The disease is caused by a fungus found in the soil and affects people with low immunity. This type of meningitis, Kamali says, is hard to treat compared to other types.
“It commonly presents with severe headache and is fatal, unless treated. The treatment is intensive, costly and not always successful. Survivors are often left with disabilities,” Nabiryo said during the launch of new findings that prove that fluconazole, an anti-fungal drug, can be used to prevent cryptococcal disease.
“If one’s CD4 count has dropped to below 100, then one has a high chance of getting the disease,” she said.
Treatment with antiretroviral therapy has led to a decrease in cryptococcal disease, says Dr. Alex Opio, the assistant commissioner in charge of disease control at the health ministry.
The new research, Opio said, will help HIV/AIDS patients enjoy a longer life without fear of the disease.
“We have had this epidemic for two decades. If we get new interventions like the one we are releasing today, we will defeat it,” said Opio.
The research, funded by the Medical Research Council through the Liverpool School of Tropical Medicine, was done in collaboration with the Uganda Research Unit on AIDS, The AIDS Support Organisation and the health ministry.
It aimed at assessing whether routine use of fluconazole, can prevent cryptococcal disease in HIV-infected patients.
One thousand five hundred nineteen HIV-positive patients were enrolled into the trial. Half of these were put on fluconazole capsules and others on placebo between November 2004 and January 2008. They were taking one capsule, three times a week.
Results One patient developed cryptococcal disease in the fluconazole group, while the number was 18 in the placebo group.
“Therefore patients receiving fluconazole were less likely to develop the disease than those on placebo,” said Dr Kamali.
Fluconazole was also found to reduce the occurrence of candida of the gullet, mouth, throat and vagina.
The research recommends that fluconazole therapy is safe and effective in preventing cryptococcal disease and should be considered in patients with advanced HIV infection, before starting antiretroviral drugs and in the early months of antiretroviral therapy until the immune system recovers.
