Following up on the goal, set in 2015, to diagnose 95% and treat 95% of serious fungal infections by year-end 2025.
Candida auris
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In 2015, fungal infections were affecting over 1 billion people globally each year, leading to an estimated 11.5 million life-threatening infections and more than 1.5 million deaths annually. Despite this significant burden, fungal diseases have historically been under-recognized and underfunded in global health. In response, initiatives focused on improving diagnosis, treatment, and prevention have gained momentum.1
The Global Action Fund for Fungal Infections (GAFFI) launched a 10-year roadmap in 2015 aimed at addressing the growing crisis, particularly among HIV/AIDS patients. Central to this initiative is the "95-95 by 2025" target, which seeks to diagnose and treat 95% of individuals with serious fungal infections by the end of 2025. The goal is to reduce mortality from common HIV-related fungal diseases like cryptococcal meningitis, Pneumocystis pneumonia, disseminated histoplasmosis, and chronic pulmonary aspergillosis, which contribute significantly to deaths in immunocompromised populations.2
According to a 2024 systematic review in The Lancet Infectious Diseases, over 6.5 million people annually develop invasive fungal infections, with 3.8 million deaths. The highest mortality rates are linked to infections caused by Aspergillus species, Candida bloodstream infections, Pneumocystis pneumonia, and Cryptococcus meningitis. Invasive Aspergillus infections alone account for 2.1 million cases and 1.8 million deaths annually. Other fungal infections such as chronic pulmonary aspergillosis, Candida bloodstream infections, and fungal asthma contribute significantly to global mortality.3
Approximately 30 fungal species cause 99% of all cases. While these infections impact people of all ages, those with weakened immune systems, such as individuals with HIV, cancer, and organ transplant recipients, are especially vulnerable. In addition to common cutaneous fungal infections, serious invasive diseases like Cryptococcus meningitis, Pneumocystis pneumonia, and Aspergillus-related diseases are a major concern.
A key challenge in managing fungal infections is the lack of timely and accurate diagnostics. Symptoms often overlap with other infections, delaying proper diagnosis and treatment. The GAFFI roadmap stresses the importance of expanding access to rapid diagnostic tests for infections such as cryptococcal meningitis, Histoplasma, and Aspergillus, noting that early detection can reduce mortality by up to 30%, particularly in high-risk settings.
Beyond diagnostics, limited access to antifungal treatments in low- and middle-income countries (LMICs) remains a critical barrier. Effective antifungal drugs, such as fluconazole and amphotericin B, are available, but their distribution is often restricted in these regions, contributing to high mortality rates. The roadmap advocates for systemic changes to ensure that essential antifungal medications are accessible and affordable, aiming to reduce the global treatment disparity.
Global fungal infections affect over 1 billion people annually, causing 3.8 million deaths, underscoring the need for better diagnosis and treatment.
The "95-95 by 2025" initiative aims to diagnose and treat 95% of serious fungal infections, focusing on reducing deaths from HIV-related fungal diseases.
Key challenges include diagnostic delays and limited access to antifungal treatments, particularly in low-income countries, contributing to high mortality rates.
The roadmap lays out a comprehensive strategy with four key areas: improved diagnostics, capacity building, access to treatment, and enhanced surveillance and research. This includes implementing rapid diagnostic tests, setting up well-equipped fungal disease laboratories, training clinicians, and expanding fungal disease surveillance to better inform treatment strategies.
As 2025 approaches, some progress has already been made. Early successes, like introducing rapid diagnostic tests for Histoplasma and Cryptococcus in high-burden regions, have shown promising results in reducing mortality. However, significant challenges remain, particularly ensuring universal access to diagnostics and treatments.
By 2025, the hope is that the "95-95 by 2025" target will significantly improve fungal disease care, saving hundreds of thousands of lives annually. Achieving this will require continued global collaboration, investment in diagnostic and treatment capacity, and ensuring equitable access to care, all of which are essential to addressing the urgent need for improved public health responses to fungal infections.
