Each year, there are an estimated 220,000 new cases of cryptococcal meningitis. Unfortunately, researchers hypothesize that this results in over 100,000 to 180,000 deaths; many of these are in those who have HIV or are immunocompromised. According to Medical Xpress, a study in Eastern and Southern Africa evaluated a new therapeutic option for those with HIV-associated cryptococcal meningitis: AmBisome, used in conjunction with flucytosine and fluconazole. In particular, the research team wanted to understand how AmBisome compared to the current standard-of-care, Amphotericin-B.
Ultimately, researchers determined that not only was AmBisome as effective in reducing the mortality rate, but it was also better tolerated than Amphotericin-B. To learn more about the study and its findings, take a look at the data published in the New England Journal of Medicine.
Currently, Amphotericin-B is the standard-of-care for cryptococcal meningitis in Africa. This treatment, which takes 7-14 days to complete, is given in conjunction with fluconazole or flucytosine pills. However, this treatment is also rife with side effects. In addition to potential nephrotoxicity, Amphotericin-B can cause gastrointestinal side effects, muscle and joint pain, unintended weight loss, and other negative reactions.
In this particular study, researchers compared AmBisome with Amphotericin-B. According to Gilead, AmBisome is:
a sterile, non-pyrogenic lyophilized product for intravenous infusion [containing] 50mg of amphotericin B, USP, intercalated into a liposomal membrane coating. The active ingredient of AmBisome acts by binding to the sterol component, ergosterol, of the cell membrane or susceptible fungi [resulting] in cell death.
To learn more about AmBisome and its benefits, head here.
Unpacking the Research
Researchers evaluated AmBisome versus Amphotericin-B in a study encompassing 814 adults with HIV-associated cryptococcal meningitis. The patients were split into two cohorts and given one of the therapies. Findings included:
- Researchers found that 25% of those in the AmBisome cohort died after a 10-week period, compared to 29% of those within the Amphotericin-B cohort.
- AmBisome only required one dose to reach these results, whereas the other treatment is given over a 1-2-week period. Therefore, AmBisome offers more of an ease of treatment.
- Additionally, there were less adverse reactions and toxicity-related reactions in patients receiving AmBisome. For example, only 13% of those receiving AmBisome had anemia, compared to 39% of those taking the other treatment.
Moving forward, AmBisome could greatly reduce the burden of cryptococcal meningitis in Africa. However, accessibility is currently an issue. However, two researchers from the study received 5-years-worth of funding to learn more about how they can increase access in Africa and improve patient outcomes.
What is Cryptococcal Meningitis?
There are more than 50 species of Cryptococcus, a type of fungus that is found in soil, bird droppings, and throughout the environment. Cryptococcus neoformans causes cryptococcal meningitis. According to the CDC:
Most people likely breathe in this microscopic fungus at some point in their lives but never get sick from it. However, in people with weakened immune systems, such as those living with HIV, Cryptococcus can stay hidden in the body and later cause a serious (but not contagious) brain infection called cryptococcal meningitis.
Cryptococcal meningitis may also be a complication of cryptococcosis. Symptoms manifest within a few days or weeks following infection. Once symptoms appear, these can include:
- Nausea and vomiting
- Confusion or hallucinations
- Neck stiffness
- Light sensitivity and/or blurred vision