Cryoptococcal meningitis

January 2007     View PDF     En español

Can meningitis be prevented?

The anti-fungal drug fluconazole (Diflucan) may be quite useful in preventing cryptococcal meningitis in people whose CD4+ counts are below 50. There is strong concern, however, that people may not benefit much in the long term from using this preventive treatment. This is partly due to the small number of people living with AIDS who become ill with cryptococcal meningitis.

Before the introduction of more powerful anti-HIV therapy, only 5–8% of all people living with HIV ever became ill with cryptococcal meningitis, and those numbers have decreased since 1996. More importantly, research shows that many people who used fluconazole to prevent cryptococcal meningitis did not respond well to fluconazole as maintenance therapy if they became ill with the disease. The other available anti-fungal drugs are less effective and may be more toxic. These therapies (itraconazole and ketoconazole) can be used effectively, however, in people who have used fluconazole extensively to prevent Cryptococcus or other fungal infections