Short-Course Amphotericin-based Treatment for Cryptococcal Meningitis
AIDS, toxicities
AIDS, DER
A program of clinical trials across sub-Saharan Africa was initiated in 2004. The aim was to develop and test new antifungal regimens, based on current drugs, that would be safer and more sustainable than the international standard of 2 weeks of amphotericin plus flucytosine, established by the AIDS Clinical Trials Group trial of van der Horst and colleagues [Subsequently, advocacy efforts and support from Unitaid and partners has led to increasing availability of more affordable generic flucytosine, and results of implementation of the 1-week amphotericin plus flucytosine regimen have mirrored the mortality reduction seen in the ACTA trial, with in-hospital mortality in South Africa reduced from 37% (based largely on the prior standard there of 2 weeks of amphotericin plus fluconazole) to 24% [However, even a 1-week course of amphotericin deoxycholate has significant toxicities [