Abstract
BackgroundAntimonials are still being used for visceral leishmaniasis (VL) treatment among HIV co-infected patients in East-Africa due to the shortage of alternative safer drugs like liposomal amphotericin B. Besides tolerability, emergence of resistance to antimonials is a major concern.ObjectivesThis study was aimed at assessing the clinical outcome of VL-HIV co-infected patients when treated with sodium stibogluconate (SSG).MethodsRetrospective patient record analysis of VL-HIV co-infected patients treated at a clinical trial site in north-west Ethiopia was done. Patients with parasitologically confirmed VL and HIV co-infection treated with SSG were included. The dose of SSG used was 20 mg Sb5 (pentavalent antimony)/kg and maximum of 850 mg Sb5 for 30 days. The clinical outcomes were defined based on the tissue aspiration results as cure or failure, and additionally the safety and mortality rates were computed.ResultsThe study included 57 patients treated with SSG and by the end of treatment only 43.9% of patients were cured. The parasitological treatment failure and the case fatality rate were 31.6% and 14.0% respectively. SSG was discontinued temporarily or permanently for 12 (21.1%) cases due to safety issues. High baseline parasite load (graded more than 4+) was significantly associated with treatment failure (odds ratio = 8.9, 95% confidence interval = .5-51.7).ConclusionSSG is not only unsafe, but also has low effectiveness for VL-HIV patients. Safe and effective alternative medications are very urgently needed. Drug sensitivity surveillance should be introduced in the region.
Highlights
Visceral leishmaniasis (VL), called kala-azar, is a vectorborne disseminated infection caused by the Leishmania donovani spp. complex, a protozoan parasite that predominantly affects tissue macrophages
We report on the clinical outcomes in a cohort of adult visceral leishmaniasis (VL)-HIV co-infected patients recruited at the Leishmaniasis Research and Treatment Center (LRTC) of University of Gondar (UoG) Hospital, Ethiopia
Study setting The study was conducted at the LRTC in the UoG that is located in north-west Ethiopia close to the main VL endemic focus in the country
Summary
Visceral leishmaniasis (VL), called kala-azar, is a vectorborne disseminated infection caused by the Leishmania donovani spp. complex, a protozoan parasite that predominantly affects tissue macrophages. The anthroponotic form is caused by Leishmania donovani and is prevalent in the Indian subcontinent (with estimated 300,000 cases/year) and East Africa (30,000 cases/ year). Within East Africa, Sudan and Ethiopia are most affected [1]. Like most other neglected tropical diseases, VL has traditionally ranked low on the national and international health agenda [2,3,4,5]. Antimonials are still being used for visceral leishmaniasis (VL) treatment among HIV co-infected patients in East-Africa due to the shortage of alternative safer drugs like liposomal amphotericin B. Emergence of resistance to antimonials is a major concern
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