Researchers at the Kenya Medical Research Institute (Kemri) are trialing an oral drug for treating cryptococcus meningitis that will be less toxic to the kidneys.
The scientists hope to provide an alternative to the current intravenous drug amphotericin B which is too toxic for the kidneys. The drug is administered in hospital and the patient has to be admitted for at least 14 days. For some people, draining spinal fluid daily to reduce pressure on the brain is also part of treatment. The new oral drug, fluconazole, is fairly tolerable and can be taken at home doing away with the need for hospital admission.
Cryptococcus meningitis (CM) is an infection of the lining of the spinal cord and brain and often attacks people with weakened immune systems or with immune disorders. It is transmitted through dust or dried bird droppings, but is not contagious. Symptoms include fever, fatigue, a stiff neck, headache, nausea and vomiting, confusion, blurred vision and sensitivity to bright light.
About one million cases of CM are reported annually and a 2015 study at the Kenyatta National Referral Hospital and Mbagathi Hospital in Nairobi, found a prevalence of 33 per cent.
Researchers were looking for an alternative treatment for the disease and wanted to test if the oral drug was safe. They enrolled 15 HIV-infected participants who were placed on three regimens i.e. 2000 mg a day, 1600 mg a day and 1200 mg a day, while verifying the safety of the drug. An interim analysis revealed that 1200 mg of fluconazole was not as effective as amphotericin and it was dropped from the study. The second stage validated 1600mg and 2000mg of fluconazole. The study was done in several countries including Uganda, South Africa and the United States. In Kenya, it was done in Eldoret and Kericho. The six-year study started in 2010 and concluded in 2016.
“We have not had any safety concerns. We are hopeful that the drug will be licensed to lessen the pain in patients while making it less expensive,” said associate investigator Debra Lang’at.
The researchers are now screening for the disease in all HIV patients with a CD4 count of less than 100.