Experts call for minimising deaths from cryptococcal meningitis in AIDS

WORLD AIDS DAY|DEATH|MENINGITIS

Experts from multiple African, European and American institutions have put out an alarm call to prioritise a strategy to end deaths from HIV-related cryptococcal meningitis by 2030.

This was in a commentary published in the prestigious journal Lancet Infectious Diseases. 

The plea came as the world on Tuesday December 1, 2020, marked World AIDS Day 2020 under theme ‘Ending the HIV/AIDS Epidemic: Resilience and Impact' which focused on creating global solidarity and providing resilient services. 

Cryptococcal meningitis is a type of meningitis caused by a fungus called Cryptococcus. 

It mainly affects people with weakened immune systems due to another illness. 

According to experts, undiagnosed and untreated fungal meningitis in AIDS caused by Cryptococcus is always fatal, but if diagnosed early and optimally treated, over 80% survive. 

In Africa today, only about 30% survive. This is immediately correctable with current tests and treatments, but needs action, according to the experts. 

Reversing deaths 

According to the World Health Organisation (WHO), cryptococcal meningitis is responsible for an estimated 15% of all HIV-related deaths globally, three quarters of which occur in sub-Saharan Africa. 

It is estimated that 223,100 cases of cryptococcal meningitis result in 181, 000 deaths each year among People Living with HIV. 

The experts have proposed enabling all communities to diagnose patients with a simple to use test for cryptococcal antigen (CrAg). 

This measure would probably cost the global community and countries $25 million per year. 

Also called for is the immediate provision of flucytosine (an antifungal medication), which improves survival by 25%. 

This medicine which was first used in the 1970s has been a WHO Essential Medicine since 2013 and would cost less than $30 million annually. 

Equally proposed is the education of healthcare workers looking after HIV patients to test with CrAg, to enable them to do lumbar punctures (a medical procedure in which a needle is inserted into the spinal canal, to collect fluid for diagnostic testing), to both use amphotericin B (also an antifungal medication) and delay anti-retroviral therapy in those with meningitis. 

The last proposal is to ensure all patients with meningitis can receive amphotericin B safely. 

The experts hope this call to action will encourage governments and organisations such as the Global Fund for AIDS, TB and Malaria, the President's Emergency Plan for AIDS Relief (PEPFAR), and other major funders of HIV/AIDS care, to request and implement these key steps. 

"If all these four measures could be instituted immediately, deaths from AIDS would fall by an estimated 80,000, less than $1000 per life saved." 

"Given the billions spent each year on HIV/AIDS programs, this is clearly worthwhile and urgent," said Professor David Denning, Chief Executive of the Global Action Fund for Fungal Infections (GAFFI) and of the University of Manchester.