The Risk and Predictors of Visceral Leishmaniasis Relapse in Human Immunodeficiency Virus-Coinfected Patients in Ethiopia: A Retrospective Cohort Study

Abongomera, Charles; Diro, Ermias; Vogt, Florian; Tsoumanis, Achilleas; Mekonnen, Zelalem; Admassu, Henok; Colebunders, Robert; Mohammed, Rezika; Ritmeijer, Koert; Griensven, Johan van

doi:10.1093/cid/cix607

Cited by 39 publications

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“…VL-HIV co-infected patients are confronted with high (initial) parasitological failure rates and high relapse rates [ 7 , 8 ]. While we recently identified pentamidine secondary prophylaxis as a promising option to reduce the relapse rates [ 9 , 11 ], achieving parasitological cure has been challenging.…”

Section: Discussionmentioning

confidence: 99%

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The initial effectiveness of liposomal amphotericin B (AmBisome) and miltefosine combination for treatment of visceral leishmaniasis in HIV co-infected patients in Ethiopia: A retrospective cohort study

et al. 2018

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BackgroundNorth-west Ethiopia faces the highest burden world-wide of visceral leishmaniasis (VL) and HIV co-infection. VL-HIV co-infected patients have higher (initial) parasitological failure and relapse rates than HIV-negative VL patients. Whereas secondary prophylaxis reduces the relapse rate, parasitological failure rates remain high with the available antileishmanial drugs, especially when administered as monotherapy. We aimed to determine the initial effectiveness (parasitologically-confirmed cure) of a combination of liposomal amphotericin B (AmBisome) and miltefosine for treatment of VL in HIV co-infected patients.Methodology/Principal findingsWe conducted a retrospective cohort study at a Médecins Sans Frontières—supported health center in north-west Ethiopia. We included VL-HIV co-infected adults, treated for VL between January 2011 and August 2014, with AmBisome infusion (30 mg/kg total dose) and miltefosine orally for 28 days (100 mg/day). Proportions of initial treatment outcome categories were calculated. Predictors of initial parasitological failure and of death were determined using multivariable logistic regression. Of the 173 patients included, 170 (98.3%) were male and the median age was 32 years. The proportion of patients with primary VL (48.0%) and relapse VL (52.0%) were similar. The majority had advanced HIV disease (n = 111; 73.5%) and were on antiretroviral therapy prior to VL diagnosis (n = 106; 64.2%). Initial cure rate was 83.8% (95% confidence interval [CI], 77.6–88.6); death rate 12.7% (95% CI, 8.5–18.5) and parasitological failure rate 3.5% (95% CI, 1.6–7.4). Tuberculosis co-infection at VL diagnosis was predictive of parasitological failure (adjusted odds ratio (aOR), 8.14; p = 0.02). Predictors of death were age >40 years (aOR, 5.10; p = 0.009), hemoglobin ≤6.5 g/dL (aOR, 5.20; p = 0.002) and primary VL (aOR, 8.33; p = 0.001).Conclusions/SignificanceInitial parasitological failure rates were very low with AmBisome and miltefosine combination therapy. This regimen seems a suitable treatment option. Knowledge of predictors of poor outcome may facilitate better management. These findings remain to be confirmed in clinical trials.

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Section: Discussionmentioning

confidence: 99%

“…As to VL treatment outcomes, both higher (initial) parasitological failure rates and higher relapse rates have been described [ 7 , 8 ]. To reduce the relapse rate, secondary prophylaxis is the way to go [ 7 , 9 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

The initial effectiveness of liposomal amphotericin B (AmBisome) and miltefosine combination for treatment of visceral leishmaniasis in HIV co-infected patients in Ethiopia: A retrospective cohort study

et al. 2018

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“…Relapse VL: a patient with a history of previous VL and discharged improved or with a negative test of cure (TOC) after treatment and who then presents with symptoms of VL after four weeks of initial VL treatment and is parasitologically confirmed and documented as relapse VL. 31 High parasite load: a parasite load grade of more than 4+ (1-10 parasites per field). If a parasite load grade is less than or equal to 3(1-10 parasites per 10-1000 fields) it is called low parasite load.…”

Section: Operational Definitionsmentioning

confidence: 99%

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

Yeshaw¹,

Tsegaye²,

Nigatu³

2020

IDR

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Background: Visceral leishmaniasis (VL) is a neglected tropical disease, affecting the poor and productive age group of a country, resulting in a huge impact on its economic development. Even though anti-leishmanial drugs reduce the incidence of mortality among VL patients, there is still death of these patients while on treatment. In this aspect, there are limited studies in Ethiopia; therefore, this study aimed to determine the incidence of mortality and its predictors among adult VL patients at the University of Gondar Hospital. Methods: Institution-based retrospective cohort study was conducted among 586 adult visceral leishmaniasis patients who were admitted to the University of Gondar Hospital from 2013 to 2018. Data were collected from the patients' charts and registration books, and analyzed using Stata 14 software. Kaplan-Meier failure curve and Log rank test was used to compare the survival probability of patients with independent variables. A multivariable stratified Cox regression model was used to identify predictors of mortality among VL patients. P≤ 0.05 was employed to declare statistically significant factors. Adjusted hazard ratio (AHR) and 95% confidence interval (95% CI) were estimated for potential risk factors included in the multivariable model. Results: A total of 586 VL patients were included in the study. The age of patients ranged from 18 to 55 years with a median age of 27 years. The incidence of mortality was 6.6 (95% CI: 5.2-8.4) per 1000 person-days of observation. Independent predictors of mortality were presence of comorbidity (AHR=2.29 (95% CI: 1.27-4.11)), relapse VL (AHR=3.03 (95% CI: 1.25-7.35)), treatment toxicity (AHR=5.87 (95% CI: 3.30-10.44)), nasal bleeding (AHR=2.58 (95% CI: 1.48-4.51)), jaundice (AHR=2.84 (95% CI: 1.57-5.16)) and being bedridden at admission (AHR=3.26 (95% CI: 1.86-5.73)). Conclusion: The incidence of mortality among VL patients was high. Mortality was higher among VL patients with concomitant disease, relapse VL, treatment toxicity, nasal bleeding, jaundice, and those who were bedridden at admission, which implies that great care should be taken for these risky groups through strict follow-up and treatments.

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“…The population within this region is highly mobile. Studies show a high risk of VL relapse in HIV patients, and the main predictors are not receiving secondary prophylaxis and ART (Cota et al, 2011;Abongomera et al, 2017). During this study, secondary prophylaxis was not routine clinical practice, however, the patient received ART.…”

Section: Discussionmentioning

confidence: 92%

Severe post-kala-azar dermal leishmaniasis successfully treated with miltefosine in an Ethiopian HIV patient

Abongomera

Battaglioli

Adera

et al. 2019

International Journal of Infectious Diseases

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The Risk and Predictors of Visceral Leishmaniasis Relapse in Human Immunodeficiency Virus-Coinfected Patients in Ethiopia: A Retrospective Cohort Study

Abstract: In East Africa, data on the risk and predictors of visceral leishmaniasis relapse in HIV coinfected patients are scarce. This study shows high risk of relapse, particularly in those not on antiretroviral therapy or with a high tissue parasite load.

Cited by 39 publications

References 20 publications

The initial effectiveness of liposomal amphotericin B (AmBisome) and miltefosine combination for treatment of visceral leishmaniasis in HIV co-infected patients in Ethiopia: A retrospective cohort study

The initial effectiveness of liposomal amphotericin B (AmBisome) and miltefosine combination for treatment of visceral leishmaniasis in HIV co-infected patients in Ethiopia: A retrospective cohort study

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

Severe post-kala-azar dermal leishmaniasis successfully treated with miltefosine in an Ethiopian HIV patient

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