Abstract
The recent development of highly sensitive and specific point-of-care tests has made it possible to diagnose HIV-associated cryptococcal meningitis within minutes. However, diagnostic advances have not been matched by new antifungal drugs and treatment still relies on old off-patent drugs: amphotericin B, flucytosine and fluconazole. Cryptococcal meningitis treatment is divided in three phases: induction, consolidation and maintenance. The induction phase, aimed at drastically reducing cerebrospinal fluid fungal burden, is key for patient survival. The major challenge in cryptococcal meningitis management has been the optimisation of induction phase treatment using the limited number of available medications, and major progress has recently been made. In this review, we summarise data from key trials which form the basis of current treatment recommendations for HIV-associated cryptococcal meningitis.
Highlights
Cryptococcal meningitis (CM), a severe infection that is fatal without treatment, occurs primarily in patients with impaired cell-mediated immunity[1]
We summarise the major trials carried out within the last 5 years using combination antifungal therapy for the induction treatment of human immunodeficiency virus (HIV)-associated CM
The management of HIV-associated CM has significantly changed in the past few years
Summary
Cryptococcal meningitis (CM), a severe infection that is fatal without treatment, occurs primarily in patients with impaired cell-mediated immunity[1]. A phase II dose-finding study[42] postulated that adjuvant sertraline therapy might increase cryptococcal CSF clearance compared with historical control data This was recently tested in the Adjunctive Sertraline for the Treatment of HIV-Associated Cryptococcal Meningitis (ASTRO-CM) randomised placebocontrolled trial in Uganda, where 460 HIV-infected patients with CM receiving combination therapy of AmB and FLU were randomly assigned to receive either sertraline (400 mg/day for 2 weeks and 200 mg/day for 10 weeks) or placebo in addition to the standard antifungal therapy.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
