The World Health Organization (WHO) has issued the first-ever guidelines for the treatment of cryptococcal meningitis – a disease ranking among the top causes of death among people living with HIV/AIDS. However, access to some of the WHO-recommended medicines ranges from difficult to non-existent in developing countries.

According to data presented by Médecins Sans Frontières (MSF) at the ICASA AIDS conference in Addis Ababa, cryptococcal disease is a major cause of illness and death in many parts of Africa.

The study looked at the cause of death among 36,664 people started on antiretroviral therapy (ART) in 25 MSF treatment programs in Africa, Asia and Eastern Europe between 2002 and 2010.

In the study, patients infected with extrapulmonary cryptococcosis had a 3.5 times increased risk of dying in the first six months after antiretroviral therapy was started, the greatest risk of all opportunistic infections associated with HIV.

“Our findings show that people living with HIV/AIDS are frequently contracting and dying of cryptococcal disease,” said Dr. Daniel O’Brien, HIV/AIDS Advisor with MSF and one of the authors of the study.

“It’s very good news there are finally clear guidelines on how to diagnose this disease early and treat it, but access to the drugs needed to treat remains a big challenge.”

The main drugs recommended by WHO include amphotericin B and flucytosine as the first line, with amphotericin B and fluconazole as alternatives when the first regimens  are unavailable or unaffordable.

Access to flucytosine is restricted by the fact that it is not registered in most countries in sub-Saharan Africa, where the HIV burden is highest. Registration barriers also exist for amphotericin B, and there have been global shortages of the drug, with South Africa and other countries likely to face stock-outs this year.

In South Africa’s KwaZulu Natal province, researchers found that only 35 percent of patients received any amphotericin B at all, with only eight percent receiving the recommended two week treatment course.

“To address HIV/AIDS properly depends on being able to prevent, diagnose, treat and cure the opportunistic infections that are ultimately causing AIDS deaths,” said Dr O’Brien.