High Parasitological Failure Rate of Visceral Leishmaniasis to Sodium Stibogluconate among HIV Co-infected Adults in Ethiopia

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.

Diagnosis of Visceral Leishmaniasis Using Peripheral Blood Microscopy in Ethiopia: A Prospective Phase-III Study of the Diagnostic Performance of Different Concentration Techniques Compared to Tissue Aspiration

“…Although the association of high parasitemia with clinical disease severity is not clearly established, high parasite burden in tissues is predictive of VL treatment failure among HIV-coinfected patients. 20 Impact of the study design on diagnostic accuracy results. Several features of this study were aimed at minimizing sources of bias.…”

Visceral Leishmaniasis Patients Display Altered Composition and Maturity of Neutrophils as well as Impaired Neutrophil Effector Functions

“…However, this combination treatment has been associated with increased rates of relapse of VL in Sudan (64). This will also be of particular relevance for VL patients coinfected with HIV that have a significantly higher risk of relapse (65) following treatment.…”

General aspects of visceral leishmaniasis with or without HIV co-infection in Northeast Brazil

“…in a large portion of co-infected patients at the time of VL diagnosis 284[23,34,35,37,38]. However, we emphasize that the diagnosis of HIV having been 285 performed before VL in most co-infected patients, these patients should be 286 immunologically less suppressed since they would be taking antiretroviral, but most of 287 19 them had a viral load above 50 copies.…”