Does timing of antiretroviral treatment influence treatment outcomes of visceral leishmaniasis in Northwest Ethiopia?

Abstract

BackgroundVisceral leishmaniasis (VL) patients with HIV co-infection should receive antiretroviral treatment (ART). However, the best timing for initiation of ART is not known. Among such individuals, we assessed the influence of ART timing on VL outcomes.MethodsA retrospective cohort study was conducted in Northwest Ethiopia among VL patients starting ART between 2008 and 2015. VL outcomes were assessed by the twelfth month of starting ART, within 4 weeks of VL diagnosis or thereafter.ResultsOf 213 VL-HIV co-infected patients with ART initiation, 96 (45.1%) had moderate to severe malnutrition, 53 (24.9%) had active TB and 128 (60.1%) had hemoglobin levels under 9 g/dL. Eighty-nine (41.8%) were already on ART before VL diagnosis, 46 (21.6%) started ART within 4 weeks, and 78 (36.6%) thereafter. Definitive cure in those starting ART within 4 weeks 59% (95% CI 43–75%) and those starting thereafter 56% (95% CI 44–68%) was not significantly different. Those starting ART before primary VL had higher 12-months mortality compared to those starting later (RR 0.6; 95% CI 0.4–0.9; p=0.012).ConclusionsVL-HIV patients are severely ill and with serious additional comorbidities. Outcomes of HIV-VL management are unsatisfactory and early ART initiation was associated with higher mortality. Further research on the optimal timing of ART initiation, and ensuring earlier diagnosis of VL patients, with improved management of comorbidities are needed.

Prognostic factors for mortality among patients with visceral leishmaniasis in East Africa: Systematic review and meta-analysis

“…We conducted a systematic review and meta-analysis of prognostic factors for mortality in VL patients in East Africa. A total of 48 studies [17,[21][22][23][24][25][26] were included, out of which 12 prognostic factors could be submitted to meta-analysis (sourced from 27 studies [17,[21][22][23][24][25][26][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47]60,65,[71][72][73]). Out of these, ten factors were found to be significantly associated with mortality.…”

“…The risk of bias assessment for all the observational studies included in the systematic review (n = 37) is given in S1 Fig, and The majority of these 25 studies [17,[21][22][23][24][25][26][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][71][72][73] scored well (low risk of bias) in three of the six domains of the QUIPS tool, i.e. study participation, study attrition, and outcome measurement.…”

Treatment outcomes of visceral leishmaniasis in Ethiopia from 2001 to 2017: a systematic review and meta-analysis

“…[ 36 ] Similarly, findings of the present study show that the overall mortality rate at 6MFU for patients with HIV infection increased 4.77 times than HIV-negative individuals. Associated with this, appropriate timing of antiretroviral therapy (ART) initiation needs to be investigated as earlier studies [ 37 , 38 ] reported poor chances of survival with early ART-initiation among HIV-VL co-infected individuals. However, the present study did not assess this issue.…”

<p>Incidence of Mortality and Its Predictors Among Adult Visceral Leishmaniasis Patients at the University of Gondar Hospital: A Retrospective Cohort Study</p>

“…Loss to follow-up: a patient who started VL treatment but interrupted treatment due to the patient leaving the hospital during the study period. 8,13,30 Primary VL case: a patient who is diagnosed with visceral leishmaniasis for the first time in which diagnosis relies on a positive serological test for VL (rK39-based rapid test and/or DAT direct agglutination test) and/or a positive parasitological test (microscopic detection of Leishmania parasites in spleen, lymph node, and bone marrow aspirates).…”