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Autor(en) / Beteiligte

Titel

Leave no one behind: response to new evidence and guidelines for the management of cryptococcal meningitis in low-income and middle-income countries

Ist Teil von

Ort / Verlag

United States: Elsevier Ltd

Erscheinungsjahr

2019

Quelle

MEDLINE

Beschreibungen/Notizen

In 2018, WHO issued guidelines for the diagnosis, prevention, and management of HIV-related cryptococcal disease. Two strategies are recommended to reduce the high mortality associated with HIV-related cryptococcal meningitis in low-income and middle-income countries (LMICs): optimised combination therapies for confirmed meningitis cases and cryptococcal antigen screening programmes for ambulatory people living with HIV who access care. WHO's preferred therapy for the treatment of HIV-related cryptococcal meningitis in LMICs is 1 week of amphotericin B plus flucytosine, and the alternative therapy is 2 weeks of fluconazole plus flucytosine. In the ACTA trial, 1-week (short course) amphotericin B plus flucytosine resulted in a 10-week mortality of 24% (95% CI −16 to 32) and 2 weeks of fluconazole and flucytosine resulted in a 10-week mortality of 35% (95% CI −29 to 41). However, with widely used fluconazole monotherapy, mortality because of HIV-related cryptococcal meningitis is approximately 70% in many African LMIC settings. Therefore, the potential to transform the management of HIV-related cryptococcal meningitis in resource-limited settings is substantial. Sustainable access to essential medicines, including flucytosine and amphotericin B, in LMICs is paramount and the focus of this Personal View.

Sprache: Englisch
Identifikatoren: ISSN: 1473-3099
eISSN: 1474-4457
DOI: 10.1016/S1473-3099(18)30493-6
Titel-ID: cdi_proquest_journals_2198535254

Format: –
Schlagworte: Africa - epidemiology, Amphotericin B, Amphotericin B - agonists, Amphotericin B - supply & distribution, Amphotericin B - therapeutic use, Antifungal Agents - economics, Antifungal Agents - supply & distribution, Antifungal Agents - therapeutic use, Antigens, Coinfection, Cryptococcus neoformans - drug effects, Cryptococcus neoformans - pathogenicity, Developing Countries, Disease, Disease control, Disease Management, Drug Administration Schedule, Drug Therapy, Combination - economics, Drug Therapy, Combination - methods, Fees & charges, Fluconazole, Fluconazole - economics, Fluconazole - supply & distribution, Fluconazole - therapeutic use, Flucytosine, Flucytosine - economics, Flucytosine - supply & distribution, Flucytosine - therapeutic use, Guidelines, Guidelines as Topic, HIV, HIV Infections - mortality, HIV Infections - pathology, HIV Infections - virology, Human immunodeficiency virus, Humans, Income, Infectious diseases, Intubation, Laboratories, Low income groups, Medical research, Meningitis, Meningitis, Cryptococcal - drug therapy, Meningitis, Cryptococcal - microbiology, Meningitis, Cryptococcal - mortality, Meningitis, Cryptococcal - pathology, Mortality, Resource management, Survival Analysis, Therapy

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