Management of HIV-associated cryptococcal disease in South Africa

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dc.contributor.authorGovender, N P
dc.contributor.authorDlamini, S
dc.date.accessioned2021-10-08T07:20:28Z
dc.date.available2021-10-08T07:20:28Z
dc.date.issued2014
dc.description.abstractIn routine-care settings, the 10-week mortality associated with cryptococcal meningitis (CM) is high, even with prompt, appropriate antifungal treatment and correctly timed initiation of antiretroviral therapy (ART). While early diagnosis of HIV infection and initiation of ART prior to the development of AIDS is the most important way to reduce the incidence of CM, a cryptococcal antigenaemia screen-and-treat intervention has the potential to reduce mortality by identifying patients prior to onset of CM. Antifungal treatment for HIV-associated CM is divided into three phases over a minimum period of 1 year: (i) a 2-week induction phase, including intravenous amphotericin B deoxycholate as a backbone; (ii) an 8-week consolidation phase with fluconazole 400 mg daily; and (iii) a maintenance phase with fluconazole 200 mg daily. Amphotericin B should be paired with another antifungal agent to maximise cerebrospinal fluid fungal clearance. World Health Organization guidelines emphasise that patients receiving amphotericin B-containing regimens should have access to a 'minimum package of toxicity prevention, monitoring and management to minimise the serious amphotericin B-related toxicities particularly hypokalaemia and nephrotoxicity'. Raised intracranial pressure is a serious and often fatal complication of CM, which requires good pressure management with repeat lumbar punctures. ART should be initiated 4 - 6 weeks after starting antifungal therapy. In many cases, relapse CM among South African patients occurs because of suboptimal adherence to secondary prophylaxis with fluconazole and/or the antifungal not being prescribed.
dc.identifier.apacitationGovender, N. P., & Dlamini, S. (2014). Management of HIV-associated cryptococcal disease in South Africa. <i>South African Medical Journal</i>, 104(12), 896 - 177. http://hdl.handle.net/11427/34924en_ZA
dc.identifier.chicagocitationGovender, N P, and S Dlamini "Management of HIV-associated cryptococcal disease in South Africa." <i>South African Medical Journal</i> 104, 12. (2014): 896 - 177. http://hdl.handle.net/11427/34924en_ZA
dc.identifier.citationGovender, N.P. & Dlamini, S. 2014. Management of HIV-associated cryptococcal disease in South Africa. <i>South African Medical Journal.</i> 104(12):896 - 177. http://hdl.handle.net/11427/34924en_ZA
dc.identifier.issn0038-2469
dc.identifier.ris TY - Journal Article AU - Govender, N P AU - Dlamini, S AB - In routine-care settings, the 10-week mortality associated with cryptococcal meningitis (CM) is high, even with prompt, appropriate antifungal treatment and correctly timed initiation of antiretroviral therapy (ART). While early diagnosis of HIV infection and initiation of ART prior to the development of AIDS is the most important way to reduce the incidence of CM, a cryptococcal antigenaemia screen-and-treat intervention has the potential to reduce mortality by identifying patients prior to onset of CM. Antifungal treatment for HIV-associated CM is divided into three phases over a minimum period of 1 year: (i) a 2-week induction phase, including intravenous amphotericin B deoxycholate as a backbone; (ii) an 8-week consolidation phase with fluconazole 400 mg daily; and (iii) a maintenance phase with fluconazole 200 mg daily. Amphotericin B should be paired with another antifungal agent to maximise cerebrospinal fluid fungal clearance. World Health Organization guidelines emphasise that patients receiving amphotericin B-containing regimens should have access to a 'minimum package of toxicity prevention, monitoring and management to minimise the serious amphotericin B-related toxicities particularly hypokalaemia and nephrotoxicity'. Raised intracranial pressure is a serious and often fatal complication of CM, which requires good pressure management with repeat lumbar punctures. ART should be initiated 4 - 6 weeks after starting antifungal therapy. In many cases, relapse CM among South African patients occurs because of suboptimal adherence to secondary prophylaxis with fluconazole and/or the antifungal not being prescribed. DA - 2014 DB - OpenUCT DP - University of Cape Town IS - 12 J1 - South African Medical Journal LK - https://open.uct.ac.za PY - 2014 SM - 0038-2469 T1 - Management of HIV-associated cryptococcal disease in South Africa TI - Management of HIV-associated cryptococcal disease in South Africa UR - http://hdl.handle.net/11427/34924 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34924
dc.identifier.vancouvercitationGovender NP, Dlamini S. Management of HIV-associated cryptococcal disease in South Africa. South African Medical Journal. 2014;104(12):896 - 177. http://hdl.handle.net/11427/34924.en_ZA
dc.language.isoeng
dc.publisher.departmentDepartment of Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.sourceSouth African Medical Journal
dc.source.journalissue12
dc.source.journalvolume104
dc.source.pagination896 - 177
dc.source.urihttps://dx.doi.org/10.7196/SAMJ.9070
dc.subject.otherMeningitis
dc.subject.othercryptococcal
dc.subject.otherHIV
dc.subject.otherSouth africa
dc.subject.otherArticle
dc.titleManagement of HIV-associated cryptococcal disease in South Africa
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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