People living with HIV who have part of the cryptococcal fungus in their blood more likely to die

10 Jun 2019
People living with HIV who have part of the cryptococcal fungus in their blood more likely to die

People living with HIV who are found to have part of the cryptococcal fungus (called CrAg) in their blood are around 3 times more likely to die than those without, despite current treatment approaches, according to new research out today [10 June 2019].

If CrAg is detected in blood it’s an indicator that the patient is at higher risk of developing cryptococcal meningitis.

The study, published in Clinical Infectious Diseases and funded by Meningitis Research Foundation, highlights better ways to identify and treat patients at greatest risk of developing cryptococcal meningitis, in order to save more lives.

Because CrAg can be detected in blood several weeks before a patient develops cryptococcal meningitis, several countries use ‘CrAg screen and treat’ strategies to try and identify patients at risk.

In South Africa, patients living with HIV with a very low white blood cell count are screened to see if they have CrAg in their blood. If they do, they are given an anti-fungal drug even if they show no signs or symptoms of cryptococcal meningitis. This is to try to reduce their risk of developing cryptococcal meningitis in future.

However, anti-fungal therapy alone doesn’t always work in the treatment of cryptococcal meningitis, and this study shows it is also inadequate for preventing deaths among patients who are found to have CrAg in their blood.

The research team investigated people living with advanced HIV in South Africa where fungal meningitis is a leading cause of death, including 67 who tested positive and 134 who tested negative for CrAg.

Based on their findings, the study authors emphasise the need to thoroughly investigate CrAg positive patients through use of a lumbar puncture and blood culture test. They highlight that additional anti-fungal drugs should be used for all patients with CrAg in their blood, or those with high levels of it, even if the patient has been diagnosed as not having cryptococcal meningitis and does not yet show any signs or symptoms of the disease.

"To fully realise the potential of reducing deaths from cryptococcal meningitis, thorough testing and alternative antifungal treatment programmes should be considered.” - Dr Rachel Wake

Study author, Dr Rachel Wake, from St George’s University of London and the National Institute for Communicable Diseases in South Africa said, “This study provides valuable insight into the causes of deaths in patients who test positive for the cryptococcal antigen. To fully realise the potential of reducing deaths from cryptococcal meningitis, thorough testing and alternative antifungal treatment programmes should be considered.”

Vinny Smith, Chief Executive at Meningitis Research Foundation said, “This research answers fundamental questions that could help doctors identify whether patients are more vulnerable to developing full blown cryptococcal meningitis, allowing them to prescribe an appropriate course of treatment at an early stage. Ultimately, this research could increase the chances of survival of people with HIV at risk of cryptococcal meningitis in the future.”

Current estimates suggest there are 214,000 cases of cryptococcal meningitis per year, with up to 70% of cases occurring in HIV prevalent areas of sub-Saharan Africa.

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