What can be done to reduce deaths from fungal infections in those with HIV?

Fungal infections have a large impact on those living with HIV-AIDS, causing many deaths a year, a recent global meeting investigated the problem.

Infections caused by fungi are usually harmless however in immune-supressed individuals they can lead to severe infection and even death. Advanced HIV infection allows fungi to have the latter more virulent effect despite antiretroviral therapies. The second EMBO Workshop on AIDS-Related Mycoses held in 2016 investigated where we are in combatting this issue and what are the key priorities for the future. Measuring the worldwide effect of fungal diseases is hard as they often develop slowly and are hard to diagnose, however it is estimated that every year there are up to a million fungal infections related to HIV-AIDS, leading to up to 500,000 deaths. This means that HIV-related fungal disease causes nearly the same number of deaths as other major infectious diseases such as malaria and tuberculosis. Histoplasmosis, a type of lung infection caused by inhaling Histoplasma capsulatum fungal spores, leads to 50% mortality (after a year) for people with HIV-associated Histoplasmosis in the Amazon region.

At last year’s EMBO AIDS-Mycoses Workshops in Cape Town, South Africa, over 100 researchers from around the world met to discuss the fight against HIV-related diseases and outline future priorities. The workshop’s organisers included Dr Darius Armstrong-James and Dr Graeme Meintjes of Imperial College who wrote a report on the findings. Read the full article on the meeting online in Trends in Microbiology for a comprehensive list of discussion points.

Even if ambitious treatment targets set by the Joint United Nations Programme on HIV/AIDS (UNAIDS) are reached there will still be significant numbers of remaining patients with fungal infections. The medical mycology global community is trying to change the lack of focus on the global issue of fungal disease. With this in mind the goals for the future have to be better access to antifungal medicines and the development of new antifungal drugs.

Five priorities were identified at the EMBO AIDS-Mycoses meeting:

• Better collaborative working structures for basic scientists and clinical researchers to accelerate translational medicine. 
• Better diagnostics and improved surveillance of fungal infections.
• Access to established medicines, as well as development of new medicines and vaccines. 
• Delivery of multi-centre clinical trials. 
• Extension of current advocacy groups and public engagement.

Also highlighted at the meeting were the newly recognised HIV-associated invasive fungal infections due to Emergomyces. It was further recognised that the cryptococcal meningitis epidemic was likely to continue; due to an unremitting increase in HIV infection rate, emerging HIV drug resistance and the challenges associated with getting patients to complete their Antiretriviral Therapy (for HIV). New research was discussed including genomics-based studies on evolution of fungi and resistance in the host, metabolic adaptation of fungal infections to the host and recent discoveries in understanding the innate and adaptive immune responses to Pneumocystis (a yeast-like fungus).