WHO issues guidelines for treatment of cryptococcal disease in HIV patients

Cryptococcal disease is one of the most important opportunistic infections among 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 was made following the results of a multicentre randomised controlled trial conducted in Botswana, Malawi, South Africa, Uganda and Zimbabwe showing that a simplified regimen with a single high dose of liposomal amphotericin B paired with other standard medicines (flucytosine and fluconazole) is as effective as the previous WHO standard of care, with the benefits of lower toxicity and fewer monitoring demands. The single high dose containing regimen was also preferred by health care providers because it took less time to prepare, required less monitoring, and may shorten a patient’s length of hospital stay. At this moment, only a few suppliers have received regulatory approval, and although a preferential pricing agreement has been negotiated with the manufacturer of the originator product, uptake has been low across low- and middle-income countries.