Update on field use of the available drugs for the chemotherapy of human African trypanosomiasis

Abstract

Despite the fact that eflornithine was considered as the safer drug to treat human African trypanosomiasis (HAT) and has been freely available since 2001, the difficulties in logistics and cost burden associated with this drug meant that the toxic melarsoprol remained the drug of choice. The World Health Organization responded to the situation by designing a medical kit containing all the materials needed to use eflornithine, and by implementing a training and drugs distribution programme which has allowed a transition to this much safer treatment. The introduction of the combination of nifurtimox and eflornithine (NECT) has accelerated the shift from melarsoprol to the best treatment available, due to reduced dosage and treatment time for eflornithine that has significantly lessened the cost and improved the burden of logistics encountered during treatment and distribution. The decrease in the use of more dangerous but cheaper melarsoprol has meant a rise in the per patient cost of treating HAT. Although NECT is cheaper than eflornithine monotherapy, an unexpected consequence has been a continuing rise in the per patient cost of treating HAT. The ethical decision of shifting to the best available treatment imposes a financial burden on HAT control programmes that might render long-term application unsustainable. These factors call for continuing research to provide new safer and more effective drugs that are simple to administer and cheaper when compared to current drugs.

Inventory of potential vectors of trypanosoma and infection rate of the Tsetse fly in the National Park of Ivindo, Gabon

“…Between 2000 and 2009, 328 HAT cases have been reported in Gabon, among them, six were European cases whom one was exposed in a rural forest area 3,29,30,31 . Moreover, data from epidemiological and entomological surveys carried out in Gabon, specifically, in the province of the Estuary and more recently, the Ogooué-Maritime region, showed the transmission of the disease in these areas 5,6,24,25 .…”

Future treatment options for human African trypanosomiasis

“…logistically, the transportation and storage of the volume of the required infusions further hampered the acceptance of eflornithine as a first-line treatment for CNS T.b. gambiense infections [16]. To address these problems, eflornithine was combined with nifurtimox in 2009 to produce a nifurtimox/ eflornithine combination therapy (NECT) that reduced the administration schedule to 14 iv.…”

Dose-dependent effect and pharmacokinetics of fexinidazole and its metabolites in a mouse model of human African trypanosomiasis

“…Although fewer than 7000 cases are reported each year, nearly 70 million people remain at risk [1]. Current therapies are limited by toxicity, route of administration and stage-specific activities [2]. Two drugs are currently undergoing clinical trials: fexinidazole and the oxaborole SCYX-7158 [3].…”