First-ever treatment guidelines released for major cause of death of people living with HIV

Médecins Sans Frontières study shows cryptococcal meningitis as leading cause of death, but access to best treatment is a major challenge.

Addis Ababa, 7 December 2011 – The World Health Organization (WHO) has issued the first-ever guidelines for the treatment of cryptococcal meningitis – a disease ranking among the top causes of death among people living with HIV/AIDS. However, access to some of the WHO-recommended medicines ranges from difficult to non-existent in developing countries.

According to data presented by the international medical humanitarian organisation Médecins Sans Frontières at the ICASA AIDS conference in Addis Ababa, cryptococcal disease is a major cause of illness and death in many parts of Africa. The study looked at the cause of death among 36,664 people started on antiretroviral therapy (ART) in 25 Médecins Sans Frontières treatment programs in Africa, Asia and Eastern Europe, between 2002 and 2010. In this study, patients infected with extrapulmonary cryptococcosis had a 3.5 times increased risk of dying in the first six months after antiretroviral therapy was started; the greatest risk of all opportunistic infections associated with HIV.

“Our findings show that people living with HIV/AIDS are frequently contracting and dying of cryptococcal disease,” said Dr. Daniel O’Brien, HIV/AIDS Advisor with Médecins Sans Frontières and one of the authors of the study.  “It’s very good news there are finally clear guidelines for how to diagnose early and treat this disease, but access to the needed drugs remains a big challenge.”

The main drugs recommended by WHO include amphotericin B and flucytosine as first choice, with amphotericin B and fluconazole as alternatives when the firs regimenis unavailable or unaffordable. Access to flucytosine is restricted by the fact that it is not registered in most countries in sub-Saharan Africa, where the HIV burden is highest. Registration barriers also exist for Amphotericin B, and there have been global shortages of the drug, with South Africa and other countries likely to face stock-outs this year.  In South Africa’s KwaZulu Natal province, researchers found that only 35 percent of patients received any amphotericin B at all, with only 8 percent receiving the recommended 2week treatment course.

“To address HIV/AIDS properly depends on being able to prevent, diagnose, treat and cure the opportunistic infections that are ultimately causing the AIDS deaths,” said Dr. O’Brien.