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A new study published in The Lancet Global Health has shed light on previously unrecognized regional differences in the causes of HIV-related infections that attack the central nervous system (CNS) in Africa. The findings are expected to revolutionize the diagnosis and treatment of these life-threatening conditions.
According to research led by Dr. Angela Loyse from City St George’s, University of London, the study uncovered crucial “blank spots” in diagnosis, which could help save thousands of lives across the continent. The results emphasize the need for tailored healthcare initiatives to target the specific infectious diseases that are prevalent in different regions.
Every year, an estimated 630,000 people in Africa succumb to HIV-related complications, with a third of these deaths linked to bacterial, fungal, and parasitic infections that attack the CNS. Cryptococcal meningitis, caused by a fungal infection of the meninges that cover the brain, has long been considered the leading cause of these deaths. However, the DREAMM study, a collaboration between researchers from institutions including the University of London, UNC Project in Malawi, and Institut Pasteur in Paris, has revealed significant regional variations in the diseases responsible for these deaths.
The study, which involved 356 participants living with HIV and suspected CNS infections, took place across five public hospitals in Malawi, Tanzania, and Cameroon. The researchers focused on strengthening laboratory and clinical facilities to speed up diagnoses and provide targeted treatments. The findings showed that the approach was highly successful, leading to accurate diagnoses in 75% of cases.
While cryptococcal meningitis remained the leading cause of CNS infections overall, responsible for 55% of cases, the study revealed unexpected patterns. In Tanzania, 60% of infections were caused by cryptococcal meningitis, while in Malawi, it accounted for 53% of infections. However, in Cameroon, cerebral toxoplasmosis—a parasitic infection of the brain—emerged as the leading cause of CNS infection, responsible for 43% of cases. This condition was rare in the other two countries, highlighting a crucial regional variation that had previously been overlooked.
Dr. Loyse stressed the importance of the study’s findings, stating, “Unless conditions like cerebral toxoplasmosis are actively sought out and treated, HIV-related deaths will continue to be preventable. This data is invaluable in helping us address the ‘blank spots’ in diagnosis and care.”
The study also identified CNS-linked tuberculosis and bacterial meningitis as significant contributors to the burden of HIV-related deaths, with variations across the three countries. In Tanzania, tuberculosis accounted for 29% of infections, while bacterial meningitis was more common in Malawi (19%). In Cameroon, cryptococcal meningitis accounted for 40% of infections.
Dr. Cecilia Kanyama, Principal Investigator of the DREAMM study in Malawi, emphasized the potential for the findings to impact public health policy. “Our study proved that strengthening routine care in African public hospitals reduced HIV-linked meningitis deaths by half,” she said. “With these new insights, we can now develop region-specific care packages that will help reduce death rates from these deadly infections.”
The study’s authors are calling for further research to fully map out the causes of CNS infections across Africa and help inform efforts to reduce HIV-related deaths, in line with the Sustainable Development Goals.
Disclaimer: The research discussed in this article was published in The Lancet Global Health. The findings may have significant implications for HIV-related healthcare in Africa, but the conclusions are based on data from a select group of hospitals in three countries. Continued research and validation across more regions are necessary to fully understand the scope of the issue.
For further information, refer to the original article: Causes of HIV-related CNS infection in Cameroon, Malawi, and Tanzania: epidemiological findings from the DREAMM HIV-related CNS implementation study, The Lancet Global Health (2025).
