Manchester University. UK: Early detection and treatment of fungal meningitis and pneumonia can save hundreds of thousands of lives, for a cost of 'only $30' per HIV patient, a conference convened by a University of Manchester academic has concluded.
At the event in Seattle, USA, policy makers, doctors and researchers
from around the world called for immediate action on fungal infections
to save lives across the world. They were speaking at the world's first
stakeholder meeting on fungal diseases, hosted by GAFFI
(Global Action Fund for Fungal Infections) and convened by The
University of Manchester’s Professor David Denning, GAFFI’s president
Currently
about 1,500,000 people die of AIDS and its complications each year.
Probably 25-33% die of fungal infections, although exactly how many is
not clear because of a lack of access to effective diagnostic tests.
Over 400,000 are thought to die of aspergillosis complicating TB, yet
diagnostics are not available in many countries.
GAFFI President and Professor of Infectious Diseases in Global Health at The University of Manchester, David Denning,
convened the meeting in Seattle. He commented: “The toll due to fungal
diseases is over 1 billion people, yet these diseases are poorly
represented by most global health organisations and national public
health bodies. Burdens vary by geography, country, co-infections,
hospital hygiene and agricultural practices. Even though the global
antifungal pharmaceutical market is about $8 billion and growing at 2-3%
annually, there are a limited number of useful antifungals.”
Over
60 experts from major health agencies, including the World Health
Organization, UNAIDS, Bill and Melinda Gates Foundation, Office for
Global AIDS Coordination (PEPFAR), Centers for Disease Control –– and
representatives from over 30 countries –– gathered to align efforts to
improve management of fungal infections.
Participants highlighted
the lack of diagnostics and access to treatments, including the oldest
antifungal drugs, that are major hurdles to improvements in many
developing countries.
A new and preliminary economic model to
analyse costs associated with treatment and care of fungal infections in
Africa was introduced at the meeting. The model indicated that early
screening and treatment, before meningitis or pneumonia develop, is cost
effective and could save patient lives. If implemented, this regimen
could potentially save $500 million and up to 140,000 lives annually,
compared with later treatment.
TB is second only to HIV/AIDS as
the greatest killer worldwide due to a single infectious agent. A common
complication of TB is ‘chronic pulmonary aspergillosis,’ a lung fungal
disease that mimics TB, and needs to be treated with antifungal drugs.
Diagnosis
requires a simple antibody test, which is not available in many
countries, especially in Africa. Incorrect diagnosis and treatment is
therefore a common occurrence. An estimated 1,200,000 people suffer from
this complication of TB, and most are never diagnosed or treated. GAFFI
recently petitioned the WHO to make the key oral drug for this
infection, itraconazole, an Essential Medicine.
Professor Denning
continued: “Discussions covered many of the gritty problems facing
patients unlucky enough to develop a serious fungal infection: from lack
of knowledge amongst doctors, slow or non-existent diagnostics, to
costly or unavailable generic antifungals. The time for action and
alignment among AIDS and TB policy makers is now.”
Stakeholders
jointly committed more action, collaboration and serious attention to
the topic. “More should be done to reduce deaths,” Dr Swarup Sarkar from
UNAIDS said during his presentation on the economic and AIDS deaths
modelling. He continued: “Many people living with HIV are starting
antiretroviral treatment too late and die prematurely as opportunistic
infections take hold. This can be prevented if efforts are urgently
scaled up to ensure the timely diagnosis of HIV as well as early
screening and treatment of opportunistic infections.”