With more than 600,000 AIDS-related deaths reported annually over the past four years, a new report emphasizes the critical need for swift implementation of proven interventions to combat cryptococcal meningitis, the second leading cause of AIDS-related mortality after tuberculosis.
The report, titled “Unchecked deaths: protecting people living with HIV from cryptococcal meningitis,” was released at the 22nd International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA) in Harare, Zimbabwe.
The report highlights a significant lack of alignment with WHO guidelines across five crucial interventions for cryptococcal meningitis, ranging from screening to treatment. While policy alignment was relatively better in Eastern and Southern Africa compared to Western and Central Africa, none of the 35 countries assessed had fully adopted WHO’s recommendations for cryptococcal meningitis and advanced HIV disease (AHD).
Dr. Justine Odionyi, Head of HIV at the non-profit research and development organization Drugs for Neglected Diseases initiative (DNDi), acknowledged recent progress but stressed the urgency of countries adopting WHO guidelines. Dr. Odionyi said, “Given that cryptococcal meningitis is responsible for a fifth of all AIDS-related deaths, countries urgently need support in adopting these guidelines and prioritizing their implementation to reach the target of ending deaths from cryptococcal meningitis by 2030.”
Cryptococcal meningitis, caused by the fungus Cryptococcus, is a major opportunistic infection in people living with HIV with CD4 counts below 200. The infection often leads to meningitis, a dangerous swelling of the membrane surrounding the brain and spinal cord. In 2019, cryptococcal meningitis accounted for an estimated 15% of the 690,000 HIV-related deaths globally.
Sharonann Lynch, Co-Director of the Center for Global Health Policy and Politics, emphasized the underrecognition, underdiagnosis, and undertreatment of cryptococcal meningitis among people living with HIV. Lynch said, “Cryptococcal meningitis among people living with HIV remains underrecognized, under-diagnosed, and under-treated – resulting in a death rate estimated to be as high as 70% in Africa, compared to 20-30% in high-income countries.”
The report’s authors called for global health actors and donors to support countries in reforming policies and implementing life-saving interventions as recommended by WHO. The report documented inadequate levels of policy alignment across all five WHO-recommended essential interventions for AHD and cryptococcal meningitis:
- Diagnosing AHD: Only 14 countries were found to be in alignment with WHO recommendations for CD4 testing for all people living with HIV entering and re-entering HIV care.
- Cryptococcal meningitis screening: Only 24 countries were in alignment with WHO recommendations for a point-of-care rapid test to detect the cryptococcal antigen (CrAg) for all people living with AHD.
- Prevention and pre-emptive treatment: Only 13 and 11 countries, respectively, adopted WHO recommendations for fluconazole to prevent the development of cryptococcal meningitis.
- Diagnosing cryptococcal meningitis: Only 15 countries aligned with WHO recommendations for a lumbar puncture to confirm cryptococcal meningitis diagnosis.
- Treating cryptococcal meningitis: Only 5 countries included WHO’s optimal treatment regimen, while 2 countries included the least optimal regimen of fluconazole-based monotherapy.
The report emphasizes the need to bridge the gap between scientific evidence and policy adoption by national health authorities, ultimately aiming to reduce AIDS-related deaths from cryptococcal meningitis.