Towards more effective therapy for leishmaniasis
Visceral leishmaniasis (VL) is endemic in Africa. If left untreated, it is fatal. Patients who get co-infected with HIV are at even higher risk of death. Current monotherapies are difficult to administer; they are toxic, costly and long-term; and may raise the issue of drug resistance development. The EU-funded AFRICOLEISH (Care package for treatment and control of visceral leishmaniasis in east Africa) project aimed to develop and deliver safe and cost-effective treatments for VL patients. The consortium also addressed VL-HIV co-infections through effective treatments and prophylactic interventions that prevent VL relapse. The team evaluated two oral treatments in preparation for future studies on drug combinations for children. Results showed that miltefosine remains an attractive option for combination with other drugs and, for children, allometric dosing gives a better outcome along with a good safety profile. A future approved trial will assess miltefosine/paromomycin combinations. In patients with VL-HIV, the pentamidine secondary prophylaxis study results indicate that pentamidine prophylaxis associated with anti-retroviral therapy prevents relapse in VL-HIV co-infected patients. In addition, VL should be detected and treated early enough in patients with HIV infection before profound immune deficiency occurs. Results of another VL-HIV trial and additional data from a cohort observational study are likely to impact the policy at world and country level. Presented at a meeting with Ministry of Health and WHO representatives in the region, results support policy change for the VL-HIV patients based on patient-adapted combined therapy of AmBisome® and miltefosine. This also includes post-treatment prophylaxis with pentamidine to reduce the rate of occurrence of relapses. AFRICOLEISH will continue to disseminate the results, which are expected to influence policy makers´ decision on revising guidelines for VL-HIV management. The experience gained in east Africa will contribute to a deeper understanding of VL control and management that may also be applicable to other areas.
Keywords
Leishmaniasis, VL, Africa, AFRICOLEISH, VL-HIV
