A group of St George’s, University of London researchers has been awarded £2.6million by the Medical Research Council (MRC) to conduct a trial of two new drug treatments for HIV-associated cryptococcal meningitis. The team will carry out a four-and-a-half-year trial at three sites in Malawi and Zambia, where cryptococcal meningitis is a major problem and often fatal.
The project is being led by Professor Tom Harrison, professor of infectious diseases and medicine, with Dr Tihana Bicanic, Dr Joe Jarvis and Dr Angela Loyse. Their collaborators include the London and Liverpool Schools of Tropical Medicine, the University of North Carolina, and the permanent secretary at the MInistry of Health in Zambia.
Cryptococcal meningitis is one of the commonest causes of death in patients with AIDS, and is associated with up to 500,000 deaths each year in Africa alone. A large proportion of patients die from the infection, in part because the current recommended drug treatment, amphotericin B for two weeks, is difficult to give in hospitals in the developing world. This is because it is relatively expensive and needs to be given intravenously. It also has side effects, often starting in the second week, meaning monitoring is needed with frequent blood tests. The alternative oral tablet treatment, fluconazole, which is available, cheap and commonly used, is much less effective.
The new trial will test two new treatments – a short, one-week course of amphotericin B, and a combination treatment of high-dose fluconazole with another drug called flucytosine – that are as fast and effective in killing the infection as two weeks of amphotericin B, and better than fluconazole alone. These will be compared with the current recommended treatment to determine if they are as good in preventing deaths from the infection.
A total of 570 patients will be involved in the trial.
The award was the only one made by the MRC as part of its global health trial programme in the latest round of grant applications. It continues SGUL’s recent high success rate of MRC grants. St George’s was named the year’s most successful higher education institution of those applying for more than 10 MRC grants in 2010/11, with six awards from 15 applications. Including the cryptococcal meningitis project, this was a total of £6,010,000 from the MRC’s £252million grant and fellowship budget.