How Applicable Is the Single-Dose AMBITION Regimen for Human Immunodeficiency Virus-Associated Cryptococcal Meningitis to High-Income Settings?
How Applicable Is the Single-Dose AMBITION Regimen for Human Immunodeficiency Virus-Associated Cryptococcal Meningitis to High-Income Settings?
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DOI：
10.1093/cid/ciac792
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发表时间：
2023-03-04
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--
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Ambisome治疗诱导优化在非洲东部和南部进行的一项（AMBITION-cm）试验表明，（10 mg/kg）脂质体阿替霉素B，与氟康唑和氟胞嘧啶的口服骨架一起给药，非劣效于世界卫生组织（WHO）推荐的治疗人类免疫缺陷病毒（HIV）的7天阿替霉素B脱氧胆酸盐+氟胞嘧啶方案-与隐球菌性脑膜炎相关，并已纳入世卫组织治疗指南。我们认为，该试验对高收入环境中HIV相关隐球菌脑膜炎的治疗也具有重要意义。我们提出的论点，支持的证据在可用的情况下，AMBITION-cm试验方案可能是作为目前推荐的14天脂质体阿替西他滨为基础的治疗，更好的耐受性，不良反应少，并赋予显着的经济和实际利益，因此，应包括作为一种治疗方案在指导艾滋病毒相关的隐球菌治疗在高收入环境。AMBITION-cm试验表明，单次高剂量脂质体阿替霉素B与口服氟康唑和氟胞嘧啶联合给药，是治疗人类免疫缺陷病毒相关隐球菌脑膜炎的有效方法。我们认为，这是一个适当的治疗选择高收入环境。
The AmBisome Therapy Induction Optimization (AMBITION-cm) trial, conducted in eastern and southern Africa, showed that a single, high dose (10 mg/kg) of liposomal amphotericin B, given with an oral backbone of fluconazole and flucytosine, was noninferior to the World Health Organization (WHO)–recommended regimen of 7 days of amphotericin B deoxycholate plus flucytosine for treatment of human immunodeficiency virus (HIV)–associated cryptococcal meningitis and has been incorporated into WHO treatment guidelines. We believe that the trial also has important implications for the treatment of HIV-associated cryptococcal meningitis in high-income settings. We advance the arguments, supported by evidence where available, that the AMBITION-cm trial regimen is likely to be as fungicidal as the currently recommended 14-day liposomal amphotericin–based treatments, better tolerated with fewer adverse effects, and confer significant economic and practical benefits and, therefore, should be included as a treatment option in guidance for HIV-associated cryptococcal treatment in high-income settings. The AMBITION-cm trial showed that a single, high dose of liposomal amphotericin B, given with oral fluconazole and flucytosine, is an effective treatment for human immunodeficiency virus–associated cryptococcal meningitis. We argue that this is an appropriate treatment option for high-income settings.
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