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Over a million AIDS deaths preventable by 2020 says GAFFI

October 24 2016

Call issued for improved diagnosis and treatment of fungal infection.

Geneva: 24th October 2016

Fungal infection causes around half of AIDS-related deaths, of which there were 1,100,000 in 20151.  A first of its kind analysis – ‘Modelling reduction in AIDS deaths’ by the University of Manchester’s Professor David W Denning2 and published today in Philosophical Transactions of the Royal Society B3 – suggests that the opportunity to save lives is being missed. 

Using 2013 data of 1.5m deaths from AIDS, around 47% (700,000) were attributable to the four most common lethal fungal infections4 and 24% (360,000) to tuberculosis (TB).  Scenarios and projections to 2020 for the reduction of avoidable deaths were constructed based on published outcomes of the real-life impact of diagnostics and generic antifungal drugs.  The Global Action Fund for Fungal Infections (GAFFI) concluded that access to rapid diagnostics and antifungals could prevent just over 1,000,000 deaths by 2020.

GAFFI analysis predicts that on the current trajectory there will be 740,000 AIDS-related deaths in 2020. GAFFI is calling for a global focus on identifying and treating fungal diseases which could reduce this figure by 42% to 426,000.

Accelerating a reduction in AIDS-related deaths: With improved access to antiretroviral therapy and a focus on diagnosing TB co-infection, deaths from AIDS have been falling.  However, progress is slower than anticipated across the world.  The UNAIDS aspirational target of zero AIDS deaths by 2015 was not met5: however, on UNAIDS numbers, there was a 41% reduction in lives lost (from 2010 at 1.76 m to 1.1 m in 2015). 

Continued failure to focus efforts on advanced HIV infection and the 47% with fungal infections means the current UNAIDS target of fewer than 500,000 annual deaths by 20206 will almost certainly be missed - as was the aspirational target of zero AIDS deaths by 2015.  Retention in care is a major factor but it is late presentation with overwhelming infection that is GAFFI’s primary concern. 

On the third anniversary of GAFFI’s inception, the Foundation established to address access to fungal diagnostics and therapy worldwide, an urgent call is being made to focus attention on preventable opportunistic infections which account for most AIDS-related mortality, with a median age of death in the mid-30s. 

Professor David Denning of GAFFI and the University of Manchester, comments: “Too many people die from AIDS, most of them adults in the prime of life.  Our analysis shows that diagnosing and treating fungal diseases complicating HIV infection will drive down AIDS deaths in the short term.  Action could and should be taken by donors, national and international public health agencies, non-governmental organisations and governments toward achieving the UNAIDS mortality reduction target and the recently announced 2030 Millennium Development Goals.”

Denning continues, “Our projections reveal that by improving access to just 60% of those who need it, over 300,000 lives could be saved per year.  By 2020, a total of over a million lives could have been saved, helping to meet the UNAIDS mortality reduction target reducing AIDS deaths to 500,000 per year.”

Dr Meg Doherty, Department of HIV and Global Hepatitis Programme, World Health Organisation, says: “The HIV/AIDS epidemic is one of the greatest global health challenges. We commend GAFFI on drawing attention to undiagnosed and untreated fungal infections among people living with HIV.  We need to do more work to better understand the contribution of fungal infections to HIV morbidity and mortality and assuring that our current recommendations on screening and treating fungal infections are implemented at country level.  The identification and early treatment of HIV should be a priority to save lives.”  

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References: Note to editors

11.1 million [940 000 – 1.3 million] people died from AIDS-related illnesses in 2015 (Fact sheet 2016 | UNAIDS and 1,340,000 is the figure used in the GAFFI analysis.   The absence of accurate death registration in many countries precludes highly accurate mortality statistics.

2 David W. Denning FRCP FRCPath FMedSci is the current President of GAFFI.  He is also Professor of Medicine and Medical Mycology, University of Manchester and the Director of the National Aspergillosis Centre (NAC), University Hospital of South Manchester, UK.

The NAC has been commissioned by the Department of Health to provide long term care for patients with chronic pulmonary aspergillosis.

3 Publication: Denning DW. How the UNAIDS target of reducing annual AIDS deaths below 500,000 by 2020 can be achieved. Phil Trans Roy Soc B, In press.  The analysis used a linear prediction scenario exercise, and compared the current slow downward trajectory of AIDS deaths with gradually increasing efforts to diagnose and treat fungal disease, as well as the benefits of increased ARVs. The HIV statistics used by GAFFI were based on 2013 deaths of 1.5 million, which were readjusted downwards in 2014 to 1.2 million, by UNAIDS, after the analysis was done. The absence of accurate death registration in many countries precludes highly accurate mortality statistics.

4 The major fungal causes of death in AIDS patients are: cryptococcal meningitis, Pneumocystis pneumonia (PCP), disseminated histoplasmosis and aspergillosis. Rapid diagnostic tools and antifungal agents are available for these diseases, and the study found that with 60% coverage, annual deaths for cryptococcal disease could fall by 70,000, PCP by 162,500, disseminated histoplasmosis by 48,000 and chronic pulmonary aspergillosis by 33,500.

5 UNAIDS 2011 – 2015 Strategy ‘Getting to Zero’

6 UNAIDS 2016 United Nations political declaration 2016:

The Global Action Fund for Fungal Infections (GAFFI): GAFFI’S vision is to reduce illness and death associated with fungal diseases worldwide. GAFFI works to improve the health of patients suffering from serious fungal infections through better patient care, improved access to diagnostics and treatment, and by provision of educational resources to health professionals. As a Geneva-based Foundation, GAFFI is the major advocacy and fund raising body for a number of implementing partners, including governments and both national and international global health agencies. GAFFI issued a 10 year Roadmap in 2015 entitled ’95-95 by 2025’ calling for 95% of the world’s population to have access to fungal diagnostics and antifungal therapy by 2025.

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