A map of deadly infectious diseases known to attack the central nervous system (CNS) of people with HIV reveals "blank spots" in diagnosis in Africa, according to research published in The Lancet Global Health.
The researchers say the new insights should help form the backbone of tailored care to reduce deaths from HIV.
An estimated 630,000 people die each year in Africa from HIV-related illnesses, with about a third caused by bacterial, fungal and parasitic infections that attack the CNS.
Cryptococcal meningitis - caused by fungal infection of the meninges that cover the brain - has long been considered the leading cause of CNS-related death.
But a study designed by researchers from St George's, University of London, the United Nations Command in Lilongwe, Malawi, and the National Institute for Medical Research in Tanzania, the Central Hospital of Yaoundé in Cameroon, the Lighthouse Trust of Malawi, the London School of Hygiene and Tropical Medicine, and the Pasteur Institute in Paris, has revealed for the first time the potential geographical disparities.
The study was conducted in five public hospitals in Malawi, Tanzania and Cameroon as part of the DREAM project, where 356 people living with HIV with suspected CNS infection were studied.
Note: The DREAM project examined the impact of improved laboratory and clinical facilities to speed up diagnosis and tailor treatment on hospital admissions, including more comprehensive training opportunities for frontline healthcare workers and laboratory technicians.
This comprehensive and practical approach, tailored to resource-limited settings, accurately diagnosed 75 (69) of the CNS infections. The research team then measured the number of patients with four major HIV-related CNS infections: cryptococcal meningitis, tuberculous meningitis, bacterial meningitis and cerebral toxoplasmosis.
· Cryptococcal meningitis is the leading cause of CNS infection, accounting for 55% of all infections. It is also the most common cause in Tanzania (60% of those infected) and Malawi (53%). Cerebral toxoplasmosis (a parasitic infection of the brain) is the leading cause of CNS infection in Cameroon, accounting for 43%, although it is less common in other countries.
· Tuberculous meningitis is the second most common cause of infection in Tanzania (29%), bacterial meningitis is the second most common cause of infection in Malawi (19%), and cryptococcal meningitis is the second most common cause of infection in Cameroon (40%).
The researchers said our data is valuable in addressing these gaps in diagnosis and care. It tells us that unless diagnoses like cerebral toxoplasmosis are sought and treated, avoidable AIDS-related deaths will continue to occur. This is a fragment of the whole of Africa. We need more data like this now to fully understand the causes of CNS infections, end AIDS-related deaths and achieve the Sustainable Development Goals.
"In the DREAM study, we showed that strengthening routine care in public hospitals in Africa could halve deaths from HIV-related meningitis," said Dr.