Cryptococcal meningitis - 10 stories that mattered in access to medicines in 2011

“To address HIV/AIDS properly depends also on being able to prevent, diagnose, treat and cure the opportunistic infections that are ultimately causing the AIDS deaths.”  
- Dr. Daniel O’BRIEN, MSF HIV/AIDS Advisor

First-ever guidelines released for treating cryptococcal meningitis, a major killer of people with HIV, but access challenges remain

For the first time ever, the World Health Organization (WHO) in December released treatment guidelines for an HIV/AIDS ‘opportunistic infection’: cryptococcal meningitis (CM).  MSF has seen in its programmes that the disease is one of the leading causes of death in people living with HIV.

Cryptococcal meningitis is a fungal infection of the membranes covering the brain and spinal cord, and is a swift killer: if undiagnosed and untreated, people may die within a month.  

But two of the drugs WHO recommends to treat the disease, amphotericin B and flucytosine, are very hard for patients in developing countries to come by.  A third drug, fluconazole, is largely available, but has proven not as effective.

Flucytosine, for example, is not registered in any country in sub-Saharan Africa, where most cases of CM occur.  Amphotericin B, too, is not registered in many African countries.

Even in South Africa, where amphotericin B is available in central health facilities, the drug is rarely available in rural district hospitals.  In rural KwaZulu Natal, for example, only 35 percent of patients on treatment for the disease received any amphotericin B, with only 8 percent receiving what is considered an optimal two-week treatment course.

One key reason the drug is not widely available in the country is because it can cause side effects in the kidney, and so is used mainly in central hospitals where patients can be closely monitored.  

There’s an improved version of this medicine that carries fewer side effects for patients, but the huge price tag on liposomal amphotericin B puts this better-tolerated treatment currently out of reach.  In South Africa, for example, it is only available in the private sector, and at a cost of US$ 2,430 for a treatment course.  

While it is definitely good news that there are finally clear guidelines for how to diagnose and treat this major killer of people living with HIV/AIDS, it is critical that the drugs needed to treat the disease are both available and affordable for all the people who need them.