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.In South and Southeast Asia, an infection with a Talaromyces fungus is one of the most important HIV-related causes of death. According to international guidelines, infections with this fungus should be treated with amphotericin B. However, this medication is expensive, difficult to obtain and has significant side effects. An alternative is the cheaper anti-fungal medication itraconazole, which is easier to take and has fewer side effects. Previous studies concluded that these medications are equally effective, but a comparative clinical study had not been conducted. However, itraconazole is already being used on a large scale in South and Southeast Asia.
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.
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”.
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.
Related news items
Ivan Zhovannik receives best presenter award at MISP25 June 2019
Ivan Zhovannik was awarded the best presenter award at the MISP 2019 (Medical Imaging Symposium for PhD students) held in Groningen.read more
Cost-effectiveness of mpMRI in active surveillance of prostate cancer25 June 2019
In European Urology Oncology Sejal Patel and colleagues evaluated the potential cost-effectiveness of including mpMRI in active surveillance for men diagnosed with low-risk prostate cancer in comparison to the standard monitoring program.read more
The gap in mortality between older and younger CRC patients has been bridged25 June 2019
In European Journal of Cancer, Nelleke Brouwer, Thea Zonneveld-Heil and colleagues showed that differences in postoperative mortality between older and younger patients with stage I-III colorectal cancer decreased. 1-year postoperative RS was almost equal for older and younger patients in 2015-2016.read more
Surgery to straighten a deviated septum improves quality of life20 June 2019
Patients with a deviated septum breathe more easily after a septoplasty and their quality of life improves. Specialists have long debated its benefits. Machteld van Egmond, Maroeska Rovers, and Niels van Heerbeek have ended the controversy with a publication in The Lancet.read more
A personal touch of Jaap ten Oever20 June 2019
In order to promote interaction amongst colleagues within RIMLS, we have a ‘personal touch’ series setting employees in the spotlight. A light-hearted manner to learn about the colleagues you know and those you don’t. This week: Jaap ten Oever.read more
Development of nationwide recommendations to support prenatal counseling in extreme prematurity20 June 2019
In Pediatrics Rosa Geurtzen et al described the development of a nationwide, evidence-based framework for prenatal counseling in extreme prematurity. It contains recommendations and tools for personalization in the domains of organization, decision-making, content, and style of prenatal counseling.read more