Aspergillosis in AIDS, A Complex Problem

Submitted by GAtherton on 24 November 2016

A recent publication by Prof David Denning examines the potential for saving a million lives over the next five years if diagnostic tests for systemic fungal infection and antifungal drugs are made more widely available in those parts of the world that have large numbers of cases of AIDS.

Some might be surprised to learn that of the 1.2million deaths worldwide due to AIDS in 2014 nearly half (47%) were due to a fungal infection. A further quarter (24%) are due to tuberculosis, some of which may also be due to fungal infection (Chronic Pulmonary Aspergillosis, CPA). With better diagnostics and treatment a major impact could be made on reducing those deaths in future. If only 60% of those that need treatment get it then the report predicts that the fall in deaths over five years from Cryptococcus (170 000), Pneumocystis (500 000), Histoplama (132 000) and Aspergillus (CPA – 90 000)  exceeds a million.

Insofar as these figures are encouraging if funding can be found to carry out diagnosis and treatment of these infections, effective diagnosis and treatment of aspergillosis in this context isn’t straightforward.

• The figure quoted of TB cases following AIDS is not yet well defined and the figure quoted above is essentially a ‘best estimate’. 
• The best method of detecting & diagnosing aspergillosis in AIDS patients is not yet clear
• TB and aspergillosis cannot be treated together as an azole antifungal drug cannot be used with a standard drug used to treat TB – rifampicin. More expensive antifungal drugs that are more difficult to give must be used (i.e. IV Amphotericin or an echinocandin)
• There are potentially serious interactions between antiretroviral drugs (used to treat AIDS) and itraconazole for example that will need to be overcome

Despite these difficulties given that so much improvement could be made in some many lives and each of those lives will probably heavily influence more lives — for example the vast majority of AIDS deaths are young adults, mothers and fathers — we must make this push to improve the lives of the people identified in this report.