Cryptococcal meningitis (CM) is associated with a high rate of mortality among people living with HIV/AIDS. Despite the use of antiretroviral therapy, which has greatly reduced the incidence of CM globally, the death toll from this fungal infection continues to be high in sub-Saharan Africa. Estimates show that Nigeria has the highest burden of CM worldwide.
Setraline, an anti-depressant drug has shown great promise as an anti-cryptococcal agent. According to a study conducted by Zhai et al and published in the journal Antimicrobial agents and chemotherapy, setraline is potently fungicidal against Cryptococcus isolates in vitro, acts synergistically with fluconazole in vitro and , in a murine model, a combination of straline and fluconazole is more effective than either drug alone due to their strong synergy in vivo.1 Treviño-Rangel et al 2, likewise demonstrated the efficacy of setraline against Cryptococcus both in vitro and in vivo in a murine model.
Rhein et al went further to test the safety and microbiological efficacy of adjunctive setraline in HIV-infected patients with CM in Uganda.3 Their study, published in the Lancet demonstrated participants who received sertraline had faster cryptococcal CSF clearance and a lower incidence of immune reconstitution inflammatory syndrome and relapse than that reported in the past. They concluded that this inexpensive and off-patent oral medication is a promising adjunctive antifungal therapy.
- Zhai et al. http://aac.asm.org/content/56/7/3758.full
- Treviño-Rangel, RJ, Villanueva-Lozano, H, Hernandez-Rodriguez, P et al. https://academic.oup.com/mmy/article/54/3/280/2579224
- Rhein et al https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)00074-8/fulltext