The anti-fungal medication amphotericin B is most effective in controlling the HIV-related fungal infections that occur frequently in South and Southeast Asia. If treated with this medication, the mortality from these infections is reduced by half compared to itraconazole, a frequently used alternative. Even though amphotericin is expensive and has many side effects, it should be more widely available. This was the conclusion of an article by an international research group, including Heiman Wertheim of Radboudumc, which was published on 17 June in the New England Journal of Medicine.
Comparing medications
During a three-year period, an international group of researchers from Vietnam, England, the Netherlands and the United States compared the effect of treatments with these anti-fungal medications at five Vietnamese hospitals. One group with 219 patients was given amphotericin, and a second group of 221 patients was given itraconazole. After two weeks, few differences were found between the groups. In the amphotericin group, 6.5% of the patients died, compared to 7.4% in the itraconazole group.
Effects differ after eight weeks
Six months after the treatment the difference between the groups suddenly became much greater: 11.3% of the amphotericin patients had died, compared to 21% of the patients who were given itraconazole. In addition, in the group that was given the alternative medication, it took longer before the patients were fungus-free, and these patients had more frequent relapses. On the other hand, the itraconazole group had fewer side effects. The effects of the two treatments began to differ only after eight weeks.
Long-term effect
An explanation for the difference between the medications can probably be found in the stronger effect of amphotericin. In patients who were given this medication, the quantity of fungus declined much faster. Heiman Wertheim: “It seems that the effect only becomes apparent in the long-term. This also explains why the previous non-comparative case studies, in which patients were tracked for a much shorter time, did not find any difference between the effectiveness of the medications.” Paul Verweij, head of the mycology laboratory at Radboudumc: “Worldwide, the disease burden of fungal infections is underestimated. This study is therefore an important step, and many patients in Asia will be able to benefit from these new findings”.
Better availability
Despite its disadvantages, the researchers concluded that the more expensive amphotericin was preferable to the cheaper alternative. For effective treatment of HIV-related fungal infections in Asia, amphotericin must become more widely available at a lower price.
More information
Marcel Wortel
information officer
Related news items
Step-up approach vs open necrosectomy for necrotizing pancreatitis
18 April 2019Another publication of the successful Dutch collaborative group on pancreatitis research with substantial contribution from Radboudumc researchers, Harry van Goor and Kees van Laarhoven.
read more
Prophylactic antibiotics reduce hospitalisations and cost in head and neck cancer patients
18 April 2019In European journal of cancer Janneke Ham and colleagues showed that prophylactic antibiotics in locally advanced head and neck cancer patients treated with chemoradiotherapy did not reduce the incidence of (aspiration) pneumonias, but did reduce hospitalisations and tended to be cost-effective.
read more
Nontuberculous mycobacteria and fungal co-infections Bonnie and Clyde?
18 April 2019In The European respiratory journal Jakko van Ingen and Sanne Zweijpfenning showed that 40% of patients diagnosed with nontuberculous mycobacterial pulmonary disease also meet diagnostic criteria for chronic pulmonary aspergillosis.
read more
ESCMID award for groundbreaking studies on NTM disease
18 April 2019Jakko van Ingen received the ESCMID Young Investigator Award for his groundbreaking work on nontuberculous mycobacterial disease.
read more
Honorary Membership Japanese Radiological Society
18 April 2019During the annual meeting of the Japanese Radiological Society in Yokohama Jelle Barentsz became honorary member.
read more
EU funded project BIOMAP led by Ellen van den Bogaard
12 April 2019Ellen van den Bogaard, theme Inflammatory diseases, leads the research on the experimental validation and functional analysis of identified biomarkers by using advanced organotypic skin models and receives a grant of €258,000.
read more