Cryptococcosis is one of the most important opportunistic infections in 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 follows the results of a multicentre randomized controlled trial conducted in Botswana, Malawi, South Africa, Uganda and Zimbabwe showing that a simplified treatment regimen with a single high dose of liposomal amphotericin B combined with other standard drugs (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 regimen was also preferred by healthcare providers because it took less time to prepare, required less monitoring, and could shorten a patient’s length of hospital stay.
These new guidelines will only result in lives saved if a proactive approach is taken to improve access to liposomal amphotericin B. Currently, only a few vendors have received regulatory approval, and although a preferential pricing agreement has been negotiated with the original product manufacturer, uptake has been low in low-income countries and intermediate.
“To get the most out of this optimized regimen, an international effort involving multiple stakeholders is urgently needed to ensure reliable and sustainable access to liposomal amphotericin B and other antifungal agents,” said Dr. Meg Doherty, Director of Global HIV, Hepatitis and STI 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 of a treatable infection.”
The 2022 Guidelines for the diagnosis, prevention and management of cryptococcosis will be available online in the coming weeks.
1. Jarvis JN, Lawrence DS, Meya DB, et al. Single-dose liposomal amphotericin B treatment for cryptococcal meningitis. N Engl J Med. 2022 Mar 24;386(12):1109-1120.