In this era of financial austerity, we do

not believe that the 75-fold cost differential (based on a 14-day course for a 70-kg adult at NHS list price including VAT) between AmBd at 1 mg/kg/day (£4.66/50 mg vial, 2 vials/day × 14 = £130.37) Vorinostat and AmBisome at 4 mg/kg/day (£116.03/50 mg vial, 6 vials/day × 14 = £9746.52) is justifiable for HIV-infected patients with normal baseline renal function and no other nephrotoxic drugs. Even use of AmBd in the first week, before switching to AmBisome, would incur a cost saving of £4808 per patient treated. Pharmacy departments can stock both preparations and support their safe prescribing by brand name. As an oral alternative to AmBd, UK guidelines are again at odds with IDSA and WHO in recommending fluconazole at the low dose of 400 mg/day, combined with 5FC. Fluconazole is a fungistatic drug associated with worse outcomes when used in initial treatment of CM [9]. Phase II trials have shown improved cryptococcal clearance

and good tolerance using doses of fluconazole up to 1200 mg/day, without or including 5FC [10-12], a combination endorsed by WHO for areas where AmBd cannot be safely administered [3]. Lastly, in the management of raised intracranial pressure (ICP), we agree with recommendations regarding CSF manometry and repeat lumbar punctures, but, given the usual resolution, with appropriate management, of high ICP within the first weeks of induction therapy, would favour use of temporary lumbar drains over shunts in situations of high ICP unresponsive to daily lumbar punctures Romidepsin [13]. In light of these arguments, we would urge the panel to reconsider their recommendations for these aspects of management of patients with CM in the UK. “
“The risk of mother-to-child transmission of HIV can be significantly reduced by giving antiretroviral drugs to both mother and child,

by an appropriate mode of delivery, and by avoidance of breast feeding [1]. However, despite routine antenatal HIV screening and high uptake of interventions to reduce mother-to-child Baricitinib transmission in the UK, potentially preventable mother-to-child transmission of HIV still occurs [2]. To try to avoid potentially preventable infection, a review of local guidelines for managing infants born to HIV-positive women was performed in the North West Perinatal and Paediatric HIV Network. Information on which maternity units in the North West of England and North Wales had delivered HIV-infected women during the years 2006–2009 (296 deliveries; two infants HIV-infected) was obtained from the National Study for HIV in Pregnancy and Childhood (NSHPC) [3]. A questionnaire was sent to each of these units, requesting a copy of their local guidelines. Local guidelines were then compared with the British HIV Association/Children’s HIV Association (BHIVA/CHIVA) guidelines for the management of HIV infection in pregnant women [1].