Cryptococcal disease is one of the most important opportunistic infections among people living with advanced HIV disease and is a major contributor to illness, disability and mortality, particularly in sub-Saharan Africa.

New guidelines developed by WHO strongly recommend a single high dose of liposomal amphotericin B as part of the preferred induction regimen for the treatment of cryptococcal meningitis in people living with HIV.

This new recommendation was made following the results of a multicentre randomized controlled trial conducted in Botswana, Malawi, South Africa, Uganda and Zimbabwe showing that a simplified regimen with a single high dose of liposomal amphotericin B paired with other standard medicines (flucytosine and fluconazole) is as effective as the previous WHO standard of care, with the benefits of lower toxicity and fewer monitoring demands (1). The single high dose containing regimen was also preferred by health care providers because it took less time to prepare, required less monitoring, and may shorten a patient’s length of hospital stay.

These new guidelines will only translate into lives saved if a proactive approach is taken to improving access to liposomal amphotericin B. At this moment, only a few suppliers have received regulatory approval, and although a preferential pricing agreement has been negotiated with the manufacturer of the originator product, uptake has been low across low- and middle-income countries.

“To see the maximum benefits of this optimized regimen, an international effort involving multiple stakeholders is urgently needed to ensure a reliable and sustainable access to liposomal amphotericin B and other antifungal agents,” said Dr Meg Doherty, Director of the Global HIV, Hepatitis and STIs Programmes. “WHO is committed to helping all countries adopt and implement this new recommendation – so that people living with HIV no longer need to die from a treatable infection.”

The 2022 Guidelines for Diagnosing, Preventing and Managing Cryptococcal Disease will be available online in the coming weeks.

Source: World Health Organization