Ministry of Health will make antifungals available to treat endemic mycoses — Português (Brasil)

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The Ministry of Health will be responsible for acquiring antifungals for the treatment of endemic mycoses – implantation, systemic and opportunistic – in People Living with HIV/AIDS (PLWHA). The decision was announced during the 11th Ordinary Meeting of the Tripartite Intermanagers Commission held in November. Until then, the ministry was responsible for acquiring and releasing antifungals to treat the general population, while states and municipalities were in charge of acquiring and distributing them to PLWHA.

Until 2020, the Ministry of Health held the amphotericin B lipid complex and itraconazole for the treatment of fungal infections in the National List of Essential Medicines (Rename). Since then, there has been an effort to expand the therapeutic set for endemic mycoses, qualifying assistance to SUS users with the most diverse fungal infections.

In 2021, flucytosine in association with amphotericin B were incorporated into the SUS and are available for the treatment of cryptococcal meningitis. Recently, anidulafungin, voriconazole and isavuconazole were incorporated, used for the treatment of systemic candidiasis and candidemia, different forms of aspergillosis and mucormycosis, respectively. The drugs are in the procurement process and should be made available to states and municipalities in the second half of 2023.

Also in 2021, in view of the suspension of the production of the amphotericin B lipid complex, the National Commission for the Incorporation of Technologies in the Unified Health System (Conitec) was asked to expand the use of liposomal amphotericin B for the treatment of fungal infections. The acquisition of this lipid formulation is exclusive for the treatment of leishmaniasis in the SUS.

Priorities

With the new agreement, centrally acquired antifungal agents will also be made available to PLWHA, including treatments for paracoccidioidomycosis, histoplasmosis, cryptococcosis and coccidioidomycosis, aspergillosis, systemic candidiasis, mucormycosis, fusariosis and other hyalohyphomycosis; phaeohyphomycosis, trichosporonosis, chromoblastomycosis, mycetomas, lobomycosis and sporotrichosis.

The Ministry of Health is prioritizing the availability of drugs for the treatment of histoplasmosis. For the other mycoses, availability will occur from 2023.

According to the general coordinator of Surveillance of Diseases of Respiratory Transmission and Chronic Conditions (SVS/MS), Fernanda Dockhorn, the agreement in CIT and the new incorporations are a great advance for the quality of life of PLWHA. “With this agreement, we are guaranteeing the implementation of the SUS principles of universality, comprehensiveness and equity. The availability of these drugs in a centralized way gives better possibilities for treatments and quality of life for PLWHA”, she said.

The Ministry of Health estimates that 56% of cases of histoplasmosis in Brazil occur in PLWHA, that is, 160 cases per year. About 6% of hospitalizations for sporotrichosis, 40 cases per year, involve patients with HIV infection. Paracoccidioidomycosis affects 1.5% of AIDS cases in Brazil, about 20 cases per year.

In general, drugs for the treatment of endemic mycoses listed in Rename are purchased centrally. Availability is made upon prior assessment, case by case, by the team responsible for endemic mycoses, as required. Requests for treatments for PLWHA must be sent together with laboratory proof of HIV reagent.

Ministry of Health



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