Millions deprived of life saving antifungal medicines, report finds

Actor and GAFFI celebrity patron Rupert Everett declared that: “We have known for over 25 years that many people with AIDS and cancer do die of fungal complications. And death is avoidable with treatment. Why on earth are commonly used antifungal medicines not provided to everyone who needs them?”

Dr Glenda Gray, President and CEO of the African Medical Research Council and Professor of Pediatrics, Faculty of Health Sciences, at University of Witwatersrand, said: “In South Africa we are addressing the HIV epidemic squarely on with greatly increased provision of anti-retroviral drugs and expanding testing.

“Fungal diseases in AIDS have not received the priority they should have, although this is now changing with our national screening program for Cryptococci meningitis. Clearly ensuring antifungal agents are available to all is an key component in reducing deaths and illness across southern Africa."

Key findings:

• One of the critical drugs for fungal meningitis in AIDS (amphotericin B) is not available in 42 countries. The other key drug for fungal meningitis, flucytosine, is unavailable in at least 95 countries. Yet both have been available in Europe and the US for over 40 years. The World Health Organization recommends they be used together to bring down mortality from 100% to 25%. Fungal meningitis is the commonest form of meningitis in sub-Saharan Africa because of AIDS.

• The 25 -year old drug, fluconazole is available in all countries and itraconazole is unavailable in just five countries. However, being available is not enough – price also matters as patients pay for their care in many countries. The daily cost of fluconazole varied from <$1 to $31 and itraconazole from <$1 to $102. In South Africa, which has the largest AIDS burden in the world and a massive TB problem, itraconazole costs about £11.60 per day – unaffordable for most people there.

*Kneale M, Bartholomew JS, Davies E, Denning DW. Global Access to Antifungal Therapy and its Variable Cost. J Antimicrob Chemother. In press.

The University of Manchester

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Millions deprived of life saving antifungal medicines, report finds