Recent advances in AIDS-related cryptococcal meningitis treatment with an emphasis on resource limited settings

ABSTRACT

Introduction: Recent advances in the treatment and prevention of cryptococcal meningitis have the potential to decrease AIDS-related deaths.

Areas covered: Targeted screening for asymptomatic cryptococcal antigenemia in persons with AIDS is a cost effective method for reducing early mortality in patients on antiretroviral therapy. For persons with symptomatic cryptococcal meningitis, optimal initial management with amphotericin and flucytosine improves survival compared to alternative therapies; however, amphotsericin is difficult to administer and flucytosine has not been available in middle or low income countries, where cryptococcal meningitis is most prevalent.

Expert commentary: Improved care for cryptococcal meningitis patients in resource-limited settings is possible, and new treatment possibilities are emerging.

KEYWORDS:

• HIV
• AIDS
• cryptococcal meningitis
• CM-IRIS
• immune reconstitution inflammatory syndrome
• review
• antiretroviral therapy
• antifungal therapy
• sertraline

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

The authors are supported by the National Institutes of Health, National Institute of Allergy and Infectious Diseases and the Fogarty International Center [R01NS086312, T32AI055433, R25TW009345].