MSF Response to New WHO Guidelines for HIV-Related Cryptococcal Disease

MALAWI 2017 © Luca Sola

Treatments now recommended by WHO are unaffordable and unavailable to most people in need

NEW YORK, MARCH 7, 2018—The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) welcomes the launch of updated guidance by the World Health Organization (WHO) this week on the diagnosis, treatment, and management of cryptococcal disease, an opportunistic infection mainly affecting people living with advanced stages of HIV/AIDS.

Cryptococcal meningitis, a severe form of the disease that affects the brain, kills more than 180,000 people every year—75 percent of whom are in sub-Saharan Africa. MSF is concerned that the updated WHO guidelines include recommendations for drugs that remain largely inaccessible to people in low- and middle-income countries where they are not widely registered and where prices keep them out of reach.

The updated WHO guidelines recommend a combination of amphotericin B deoxycholate and flucytosine as the first line treatment option. The price of flucytosine is approximately $120 for a week-long course. While not included in the new WHO guidelines, but which is preferred by treatment providers as it is considered safer— liposomal amphotericin B (L-AmB)—is more than $500 for a week-long course.

In addition to addressing these high price tags, countries and pharmaceutical corporations must accelerate registration of flucytosine and L-AmB, and countries need to update their national guidelines to include these lifesaving drugs.

“It is disheartening to see that despite increased access to antiretrovirals, which enable long and healthy lives, opportunistic infections like cryptococcal meningitis continue to drive illness and death among people living with HIV. The new WHO guidelines give countries a much-needed roadmap for screening and treating cryptococcal meningitis. The critical aspect is implementing these guidelines. We hope that access to these two drugs will not be hampered by unaffordable prices and lack of will by governments and pharmaceutical corporations to make them available.”

—Gilles Van Cutsem, senior HIV/TB advisor for MSF’s Southern Africa Medical Unit

“The treatment guidance has changed, but the access situation hasn’t. For many sub-Saharan African countries, treatment remains out of reach and unaffordable largely due to lack of registration of the two drugs and a high price tag for the recommended treatment of this deadly disease. People with cryptococcal meningitis will continue to die unless a concerted effort from countries and pharmaceutical corporations is made to ensure access.”

—Jessica Burry, HIV pharmacist for MSF's Access Campaign