Primary prophylaxis of cryptococcal disease with fluconazole in HIV-positive Ugandan adults: a double-blind, randomised, placebo-controlled trial

Abstract

Medical Research Council, UK, and Rockefeller Foundation.

Future strategies for the treatment of cryptococcal meningoencephalitis in pediatric patients

“…The number of patients given prophylaxis in order to prevent one case of cryptococcal disease was 45. There was a decrease in cryptococcalassociated death, an effect on hospitalization and all-cause mortality [100]. This result is consistent with data from randomized controlled trials utilizing antifungal therapy (fluconazole and itraconazole) for the primary prevention of cryptococcal disease among adults with CD4 cell counts < 150 cells/mm 3 [33,101].…”

“…One approach is to administer prophylaxis to all at-risk patients. This strategy has been evaluated in adult patients in a prospective, double-blind, randomized trial with CD4 cell counts < 200 cells/mm 3 [100]. The number of patients given prophylaxis in order to prevent one case of cryptococcal disease was 45.…”

Minimizing fungal disease deaths will allow the UNAIDS target of reducing annual AIDS deaths below 500 000 by 2020 to be realized

“…The incidence of cryptococcal infection is likely to fall as 90–90–90 rolls out. Some countries use extensive fluconazole prophylaxis, as this strategy antedated screen and treat, and this is also effective in preventing cryptococcal meningitis and deaths [32]. However, the potential gains estimated here in terms of survival are probably conservative overall, given the baseline assumptions used.…”

Estimated burden of fungal infections in Kenya

“…We have assumed a conservative rate of 7% in those with CD4+ cell counts <100×10 6 /L [15,16]. In Uganda it was 1.1% of all HIV patients [17] and 12% in all HIV Sub Saharan Africa [18][19][20]. There is evidence that earlier screening and prophylactictreatment with fluconazole prevents cryptococcal meningitis infections in HIV patients [17] and is a less expensive therapy option [21][22][23].…”