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Cryptococcal meningitis persists despite 90-90-90 – Botswana experience

July 18 2016

At the EMBO Mycoses in AIDS meeting in Cape Town, Dr Joe Jarvis working in Gabarone, Botswana questioned the value of 90-90-90 in reducing cryptococcal meningitis.

Incidence of cryptococcal meningits

Just published in the prestigious journal Lancet HIV, is Botswana's record in rolling our 90-90-90 antiretroviral therapy.  Botswana achieved: 83·3% individuals knew their HIV status, among these 87·4%, were receiving ART and 96·5%, had viral load of <400 copies per mL - 70·2% with virological suppression, close to the UNAIDS target of 73%. This performance is probably the best in Africa and exceeds performance for most countries across the world, with the exception of several European countries.

Despite this excellent nationwide performance, the rate of cryptococcal meningitis has not changed (see red line in the figure showing cases per year. The majority of patients with cryptococcal meningitis were patients in care, not newly presenting patients with a new diagnosis of AIDS.

Dr Jarvis commented; “Cryptococcal meningitis is not going away any time soon. If Botswana, with its strong HIV treatment program, still has a continuing problem with cryptococcal meningitis, the situation across sub-saharan Africa must be worse. Cryptococcal meningitis requires a rethink – only 40% of these patients are still alive at 12 months.”

Over 100 researchers from across the world met at the 2nd Mycoses in AIDS meeting in the University of Cape Town  July 13-15th 2016 to share experience and forge new collaborations. The meeting covered cryptococcal meningitis, Pneumocystis pneumonia, disseminated histoplasmosis, Talaramyces marneffei infection, mucosal candidiasis, the immunopathology of fungal disease and antifungal resistance. A call to arms was published following the first meeting in 2014.

Lancet HIV article