The fungal infection cryptococcal meningitis is responsible for more than 180,000 deaths per year worldwide, mainly in HIV-infected patients.
Current treatment for this type of meningitis is difficult and mortality rates in Africa in routine care are in the region of 70% - as high as for the Ebola virus infection. Under the new suggested treatment regimen, the research indicates this would fall to 25-35% - potentially saving up to 80,000 lives a year.
An international team led by Professor Tom Harrison at St George’s, University of London has published results of their Advancing Cryptococcal Treatment for Africa (ACTA) Trial in the New England Journal of Medicine which shows relatively simple changes can save tens of thousands of lives a year.
In the light of the new findings, the World Health Organisation (WHO) has issued new Cryptococcal Disease guidelines recommending a one-week drug course.guidelines
The shorter, safer and more effective antifungal drug regimen treats cryptococcal meningitis with a one-week combination antifungal regimen of amphotericin B and flucytosine for the initial induction phase of treatment. This one-week regimen has been shown to reduce mortality by at least a third, compared to the previously recommended two-week regimen.
Tom Harrison, Professor of Infectious Diseases, said: “The research programme has taken 15 years and has at times been a long hard journey but we are delighted to be able to show a way forward to dramatically cut the number of deaths from meningitis.
“We are calling for the generic manufacture and widespread availability of the drug flucytosine, and plan large-scale programmes of implementation with partner countries and international agencies that could result in the mortality from this dreaded infection being halved.
“Our trial has shown beyond doubt that flucytosine is an essential medicine for the treatment of meningitis related to HIV. However, it is currently completely unavailable in Africa which is where three quarters of the global cases occur.”
The St George’s team worked with partners at Liverpool School of Tropical Medicine, The Institut Pasteur, Paris Descartes medical school and hospitals in Malawi, Zambia, Cameroon and Tanzania for the study whose results were announced at the International AIDS Society meeting in Paris on July 24.
The trial, funded by the UK Medical Research Council and the ANRS (the French national agency for research on AIDS and viral hepatitis), is the largest conducted to date, including over 700 participants, on the treatment of cryptococcal meningitis.