News items Aziatische HIV-patiƫnt met dodelijke schimmelinfectie zit vast aan duur medicijn
23 June 2017

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.
 
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.

Related news items


DeepRank: a deep learning framework for data mining 3D protein-protein interfaces

8 December 2021

Li Xue and colleagues recently published ''DeepRank, a deep learning framework for data mining 3D protein-protein structures'' on Nature Communications.

read more

Johan van der Vlag chairs Scientific Advisory Board Mercurna

8 December 2021

Johan van der Vlag will strengthen the development path of mCura1, Mercurna's lead formulation for chronic kidney disease as chair of the Scientific Advisory Board of the Biotech.

read more

Vote for the Supervisor of the year

7 December 2021

Now you have the chance to vote for your preferred candidate. Have fun, and go for it, support and promote your ideal supervisor. Please submit your vote at the latest 20 December 2021.

read more

Yvonne Schoon appointed professor by special appointment 'The right care for the right older person' 

6 December 2021

Yvonne Schoon has been appointed professor by special appointment 'The right care for the right older person' at the Radboudumc / Radboud University as of 1 October 2021.

read more

David Burger top scientist on anti-HIV medication

6 December 2021

Professor of Clinical Pharmacy David Burger, affiliated with the Radboudumc Pharmacy, is in the list of top scientists in the field of anti-HIV medication.

read more