Epidemiologist recommends 'flucytosine' for treatment in Africa

Molloy of St George’s University, London, made the recommendation on Monday at the ongoing 9th IAS Conference on HIV Science in Paris, France.

She said that the conclusion on flucytosine was a result of a trial.

Wikipaedia, the free encyclopedia, defines Cryptococcosis, also known as cryptococcal disease, as “a potentially fatal fungal disease.

“It is caused by one of two species; Cryptococcus neoformans and Cryptococcus gattii.

“Cryptococcosis is believed to be acquired by inhalation of the infectious propagule from the environment.’’

In spite of the increased global anti-retroviral therapy coverage, the incidence of HIV-associated cryptococcal meningitis has not decreased and is responsible for over 100,000 deaths every year in Africa.

Molloy said: “World Health Organisation (WHO) inductive antifungal therapy relied on daily infusions of amphotericin B(AmB) plus oral fluconazole for two weeks, followed by a consolidation and maintenance treatment with oral fluconazole.

“AmB is an effective antifungal, which is scarce in resource-limited countries and sometimes results in serious side effects.’’

Molloy said that they had engaged in Advancing Cryptococcal Meningitis Treatment for Africa (ACTA) Trial to arrive at the conclusion on flucytosine.

“Fluconazole is most commonly used in resource-limited settings; short (one week) induction with amphotericin-based treatment and oral therapy of high-dose fluconazole plus flucytosine.

“The current “gold standard” treatment for Cryptococci meningitis is amphotericin plus flucytosine for two weeks, but this regimen is often unavailable in low-income countries,’’ she said.

Molloy said that the ACTA trial was sponsored by Medical Research Council, UK and French National Agency for Research (ANRS).

She said that the ACTA trial enrolled 721 participants with first-episode cryptococcol meningitis in Malawi, Zambia, Cameroon and Tanzania.

The epidemiologist said two new strategies that could be both sustainable in Africa and more effective than fluconazole was explored.

She said that researchers had in the amphotericin arms, compared fluconazole and flucytosine as adjunctive treatments and found that flucytosine was superior.

Molloy said study results showed that one week of amphotericin plus flucytosine and two weeks of the oral combination of fluconazole plus flucytosine, both provided safe, effective and sustainable induction therapy.