People living with HIV/AIDS, who also have meningitis, should delay starting anti-retroviral therapy (ART) by four to six weeks for better treatment outcomes, findings from a new trial show.

The Cryptococcal Optimal Antiretroviral Timing (COAT) trial conducted by the Infectious Diseases Institute of Makerere University on 177 patients with Meningitis at Mulago Hospital, found out that 15 per cent of patients with fungal meningitis who were started on ART early died, compared to those who delayed initiation of ART.

The findings were published in the June 26, 2014 issue of the New England Journal of Medicine.

The study found that waiting four to six weeks to start HIV therapy after cryptococcal meningitis diagnosis resulted in 15 per cent better survival than starting HIV therapy one to two weeks after diagnosis.

“Due to the high rate of death, the study investigated whether six-month survival could be improved by starting HIV therapy earlier while still hospitalized, instead of waiting to start HIV therapy in an outpatient clinic four to six weeks after diagnosis,” Dr. David Meya, the Head of the study at the College of Health Sciences, Makerere University, said.

The research study involved 177 participants, of whom half received earlier HIV therapy at one to two weeks and half received deferred HIV therapy at four to six weeks.

The study was stopped midway by the US National Institute of Health two years earlier than planned after a safety review conducted by the researchers revealed the 15 per cent difference in survival.

The findings of the COAT trial have already informed international HIV guidelines (including those of the World Health Organisation, Uganda, South Africa, and United States) prior to this publication.

About Meningitis
What it is. Cryptococcal meningitis is a deadly fungal infection around and in the brain, according to Dr David Meya, the Head of the study at the College of Health Sciences, Makerere University.

Cause. According to the World Health Organisation, Fungal meningitis is the most common cause of meningitis in adults in Africa.

Habitat. The fungus lives in the environment, and people are exposed to it by breathing it in all the time. It affects mostly people with weakened immune systems and in Uganda, mainly in people with advanced HIV/Aids.

Victims. An estimated 10,000 Ugandans are infected with the fungus every year and majority of them die.

By Agatha Ayebazibwe (Daily Monitor)
Posted Tuesday, September 2, 2014 at 01:00