Recent advances in managing HIV-associated cryptococcal meningitis.
Recent advances in managing HIV-associated cryptococcal meningitis.
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DOI：
10.12688/f1000research.17673.1
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发表时间：
2019-01-01
期刊：
影响因子：
--
通讯作者：
Lortholary, Olivier
中科院分区：
文献类型：
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作者：
Boyer-Chammard, Timothee;Temfack, Elvis;Lortholary, Olivier
最近发展出的高灵敏度和特异性的即时检测方法，使在几分钟内诊断出与艾滋病毒相关的隐球菌性脑膜炎成为可能。然而，新的抗真菌药物在诊断上的进步并没有跟上，治疗仍然依赖于旧的非专利药物：两性霉素B、氟胞嘧啶和氟康唑。隐球菌脑膜炎的治疗分为诱导、巩固和维持三个阶段。诱导阶段旨在大幅减少脑脊液真菌负担，是患者生存的关键。隐球菌性脑膜炎管理的主要挑战是利用有限数量的可用药物优化诱导期治疗，最近取得了重大进展。在这篇综述中，我们总结了来自关键试验的数据，这些试验构成了当前hiv相关隐球菌性脑膜炎治疗建议的基础。
The recent development of highly sensitive and specific point-of-care tests has made it possible to diagnose HIV-associated cryptococcal meningitis within minutes. However, diagnostic advances have not been matched by new antifungal drugs and treatment still relies on old off-patent drugs: amphotericin B, flucytosine and fluconazole. Cryptococcal meningitis treatment is divided in three phases: induction, consolidation and maintenance. The induction phase, aimed at drastically reducing cerebrospinal fluid fungal burden, is key for patient survival. The major challenge in cryptococcal meningitis management has been the optimisation of induction phase treatment using the limited number of available medications, and major progress has recently been made. In this review, we summarise data from key trials which form the basis of current treatment recommendations for HIV-associated cryptococcal meningitis.