Currently about 1,500,000 people die of AIDS and its complications each year. Many die of fungal infections – how many is not clear because of a lack of access to excellent diagnostic tests.
In Seattle, over 60 experts from major health agencies, including the World Health Organisation, UNAIDS, Bill and Melinda Gates Foundation, Clinton Health Access Initiative, Office for Global AIDS Coordination, Centers for Disease Control The Global Fund – and representatives from over 30 countries –– gathered to align on efforts to improve management of fungal infections.
Delegates highlighted the lack of diagnostics and access to treatments, including the oldest antifungal drugs, as major hurdles to improvements in many developing countries.
A key output of the meeting based on a preliminary model created to analyze the costs associated with treatment and care of fungal infections in Africa, showed that early screening and treatment, before meningitis or pneumonia develop, is cost effective. If implemented, this regimen could potentially save nearly $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.
GAFFI President and Professor of Infectious Diseases in Global Health at the University of Manchester, Dr. David Denning, convened the meeting and commented afterwards: “The toll due to fungal diseases is over 1 billion people, yet these diseases are poorly represented by most global health organizations 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 per cent annually, there are a limited number of useful antifungals.
Discussions covered so many of the gritty problems facing patients unlucky enough to develop a serious fungal infection. From lack of doctor knowledge, slow or non-existent diagnostics to costly or unavailable generic antifungals, everything was discussed. The time for action and joined up thinking among AIDS and TB policy makers is here”, he added.
Stakeholders jointly committed more action. “Serious attention, study and efforts are needed, more should be done,” Dr Swarup Sarkar from UNAIDS said during his presentation.
Issued by Susan Osborne, Director of Communications, The Goodwork Organisation. Email susan.0@thisisgoodwork.org or telephone +44 7836 229208.
Images/photos available on request or see www.GAFFI.org.
Notes to Editors
Globally, over 300 million people of all ages suffer from serious fungal infections every year resulting in 1,350,000 deaths. Like Malaria with 627,000 deaths and tuberculosis with 1,300,000 deaths annually (2013), many deaths from fungal infection are avoidable. Most serious fungal infections are ‘hidden’, occurring as a consequence of other health problems such as asthma, AIDS, cancer, organ transplant and corticosteroid therapies. All require specialised testing for diagnosis, and delays or missed diagnosis often lead to death, serious chronic illness or blindness. While antiretroviral therapy of HIV infection is essential, many patient die of fungal disease before antiretroviral treatment, or in the first year of therapy.
GAFFI is a registered International Foundation based in Geneva, focussed on four major tasks related to serious fungal infections. These are:
- Universal access to fungal disease diagnostics for serious fungal disease
- Universal access to generic antifungal agents – current status by country here: http://www.gaffi.org/why/burden-of-disease-maps/
- Better data on the number and severity of fungal infections
- Health professional education related to better recognition and care for patients with serious fungal disease.
Cryptococcal infection
Cryptococcal infection, which progress to meningitis is fatal unless diagnosed and treated. The best drugs for meningitis are amphotericin B and flucytosine. Fluconazole is less effective and so 50-70% of people die of this infection in many countries, through lack of the best drugs. Currently there are an estimated 370,000 patients infected. In the modeling, based on Uganda prices, the cost of treating these patients was estimated at over $735 million, with approximately $500 million in antifungal drug costs. This assumes that amphotericin B and flucytosine area available, which often they are not. An alternative approach is to screen those with low CD4 cell counts for cryptococcal antigenemia, and treat with fluconazole, which is probably effective in preventing meningitis in most. A screen and early treatment strategy implemented for 60 per cent of patients would cost just over $400 million, with $300 million in antifungal costs. This earlier intervention was estimated to save more than 120,000 lives due to improved clinical outcomes.
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