Cryptococcal meningitis is responsible for more than 100,000 HIV related deaths every year.
It is the most common type of meningitis for adults in regions that have high rates of HIV and accounts for 10 to 20% of all HIV related deaths.
The current international standard of treatment for HIV positive adults with cryptococcal meningitis is not widely available in low-resource settings. Due to this, countries often opt for cheaper and more generic methods of initial therapy that result in higher mortality rates for affected populations.
Recently published in the New England Journal of Medicine, the Advancing Cryptococcal Meningitis Treatment for Africa (ACTA) Study shows that a shorter one-week combination antifungal regimen of amphotericin B and flucytosine reduces mortality by at least a third, compared to the previously recommended two-week regimen. In addition, the fully oral combination treatment of fluconazole and flucytosine is non-inferior to the other arms, which is a regimen that is feasible in even the most resource-limited circumstances.
The ACTA study also shows that using the drug flucytosine in combination with other antifungals yields the best results for resource-limited settings.
Flucytosine is not widely available in regions of high HIV prevalence, however it could be produced generically and made available in Africa at reasonably affordable costs.
The study shows beyond a doubt that there is need to for improved access to flucytosine and its use as a method in treatment in low-resource settings for HIV positive adults burdened by cryptococcal meningitis.
Dignitas International was involved in the ACTA Study in Malawi alongside country lead, University of North Carolina and partners including the Malawi-Liverpool Wellcome Trust Clinical Research Programme (MLW) and Malawi’s Ministry of Health (MoH). The international study trial sites in Cameroon, Malawi, Tanzania and Zambia and was led by Professor Tom Harrison at St. George’s, University of London.