Botswana enrolls first patient in Ambition Study

12th February 2018
Dr David Lawrence Source:The Midweek Sun


By Rachel Raditsebe -

The first patient has been enrolled in a study aimed at improving cryptococcal meningitis treatment to cut Botswana’s HIV/AIDS death toll, Ambition Study Lead Clinician, Dr David Lawrence has revealed. A total of 850 patients will be recruited in six (6) sites in Botswana, Malawi, South Africa, Uganda and Zimbabwe, making this the largest trial ever conducted for this HIV-associated co-infection. In Botswana, the first patient was recruited at Princess Marina Hospital (PMH) last week Wednesday, with 90 more expected to be recruited in the next two years.

Addressing journalists during a workshop meant to help them understand the new biomedical HIV prevention methods like Pre-Exposure Prophylaxis at Woodlane Hotel recently, Ambition Study Lead Clinician, Dr David Lawrence said the simplified treatment protocol could significantly reduce the risk of dying from HIV-associated cryptococcal meningitis. Cryptococcal meningitis (CM), which lives in the environment and is contracted through breathing, is the leading cause of death in HIV/Aids patients in sub-Saharan Africa after tuberculosis.

For people who have been exposed, the fungus remains largely dormant in the body and most will never fall ill. But for those living with a compromised immune system, infection can spread from the lungs to the brain and spinal cord, causing meningitis. Symptoms include headache, nausea, fever, fatigue, irritability, sensitivity to light and stiff neck amongst others.

Dr Lawrence is part of the team working on the Ambitious-cm project which began in May last year to compare the current standard treatment of CM with a single high-dose intravenous shot, a newer and cleaner form which has fewer side effects. The current recommended treatment for CM in HIV-infected patients is a two-week course of amphotericin B, an old and toxic drug, with mortality around 20-50 per cent of patients. Treatment requires a daily intravenous infusion; frequent blood tests to monitor side effects and a prolonged hospital stay.

This makes the standard course of amphotericin B difficult to administer in most developing countries. “If effective, the once-off treatment would provide for the first time a safe and shortened treatment for cryptococcal meningitis thus transforming the management of late-stage HIV infection in Africa. There will be less (sic) deaths, less time spent in hospital and they will have fewer side effects,” he stated.

Dr Lawrence explained that the fungal infection is the most common form of meningitis in many parts of Africa. "It amounts for 15% of all HIV-related mortality," he said. "Despite the rollout of antiretroviral programmes across Africa, the problem of cryptococcal meningitis is not going away." This he attributed to late diagnosis of HIV, linkage to care and poor adherence to ART, which he said, are a major determinant of disease progression and mortality. While there is no national data on the disease, in the last six months, Princess Marina Hospital alone recorded 41 cases of CM.

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