Leishmaniasis&amp;ndash;HIV coinfection: current challenges

Lindoso, José Ângelo Lauletta; Cunha, Mirella Alves; Queiroz, Igor Thiago; Moreira, Carlos Henrique Valente

doi:10.2147/hiv.s93789

Cited by 67 publications

(45 citation statements)

References 82 publications

(110 reference statements)

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“…Selected studies reported the outcomes of patients treated with either SSG or MA according to the recommended WHO dosing regimen (20 mg/kg/day parenterally for 28-30 days) and contained data for 10 or more patients about the initial (end-of-treatment) and/or final (six-month follow-up) cure that permitted calculation of the proportion of treatment failures. Given that the efficacy of Sb(V) against VL in patients co-infected with HIV-1 has been shown to be reduced 17 , 18 , only studies in which fewer than 5% of patients were HIV-1 positive or all HIV-1 patients could be statistically excluded were selected. Study populations for which HIV-1 prevalence was not reported were included.…”

Section: Selection Of Studiesmentioning

confidence: 99%

Treatment failure of pentavalent antimonial therapy for human visceral leishmaniasis: a meta-analysis

Jones¹,

Welburn²,

Jones³

2019

Journal of Global Health Reports

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Back Background ground Visceral leishmaniasis is found primarily in developing countries and is a neglected tropical disease that causes approximately 300,000 new cases and 20,000 deaths annually and is often fatal if untreated. Monotherapy with pentavalent antimonials (SSG or MA) is a second-line treatment option in many endemic areas. This meta-analysis provides regional and national analyses of the proportions of antimonial treatment failures at the end-of-treatment and at follow-up according to the drug used. Methods Methods This meta-analysis was conducted in accordance with the PRISMA guidelines. Studies were identified by systematic searches of five electronic databases. Studies in English that reported the outcomes of 10 or more patients treated according to the World Health Organization (WHO) pentavalent antimonial regimen (20 mg/kg/day for 28-30 days) were included. Random-effects meta-analyses and funnel plots were performed, and bias was assessed using tools from the Cochrane collaboration. R Results esults 33 articles were included in the final per protocol analyses, 16 from the Indian subcontinent (India and Nepal), 15 from East Africa and one from each of Iran and Turkey. Data were analysed by drug type regionally, nationally and temporally. Six-month follow-up data from 13 studies (n=797) on the Indian subcontinent gave a sodium stibogluconate (SSG) failure rate of 11.34% (95% confidence interval (CI)=7.05-16.48%). Nationally, the SSG failure rate across 11 studies from northern India greatly exceeded that identified from two Nepalese studies. Six-month follow-up data from three studies (n=638) from East Africa gave an SSG failure rate of 6.25% (95% CI=4.51-8.25%). End-of-SSG-treatment failure rates across the Indian subcontinent (n=1,135), northern India (n=990) and Nepal (n=145) were 39.82% (95% CI=31.67-48.27%), 45.21% (95% CI=39.31-51.17%) and 12.17% (95% CI=7.40-17.93%) respectively. A lower end-of-SSG-treatment failure rate was recorded in East Africa (n=53,335), 6.60% (95% CI=2.94-11.58%). No studies contained six-month follow-up data regarding meglumine antimoniate (MA), and only four studies (n=257) contained end-of-MA-treatment data with a failure rate of 5.01% (95% CI=2.70-7.98%). C Conclusions onclusions Sb(V) remains an important second-line therapy in many areas. Knowledge of failure rates can inform policy decisions at all levels. The findings of this study are most applicable to SSG therapy, confirm the known patterns of resistance and reflect current policies. Visceral leishmaniasis (VL; also known as kala-azar) is a neglected tropical disease that is typically fatal if left untreated. Globally there are an estimated 300,000 cases and over 20,000 deaths each year, with over 616 million people thought to live endemic areas at risk of VL infection. 1 Two species of Leishmania are known to cause VL. The protozoa are transmitted by sand flies, and in East Africa, the Yemen and the Indian subcontinent VL is caused by anthroponotic transmission of L. donovani, while zoonotic transmissio...

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Section: Selection Of Studiesmentioning

confidence: 99%

Treatment failure of pentavalent antimonial therapy for human visceral leishmaniasis: a meta-analysis

Jones¹,

Welburn²,

Jones³

2019

Journal of Global Health Reports

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“…Enzyme Linked Immunosorbent Assay (ELISA) is another serological test which is more useful in detecting visceral leishmaniasis. Immunochromatographic tests such as rK39 test which is based on recombinant K39 antigen are also performed in the detection of leishmaniasis [13, 23]. In the diagnosis of CL, Leishmanin Skin Test (LST) can be used in order to measure delayed hypersensitivity caused by CL [24, 25].…”

Section: Diagnosis Of the Diseasementioning

confidence: 99%

Potential Challenges of Controlling Leishmaniasis in Sri Lanka at a Disease Outbreak

Wijerathna

Gunathilaka

Gunawardana

et al. 2017

BioMed Research International

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The present works reviewed the existing information on leishmaniasis in Sri Lanka and in other countries, focusing on challenges of controlling leishmaniasis in the country, in an outbreak. Evidence from recent studies suggests that there is a possibility of a leishmaniasis outbreak in Sri Lanka in the near future. Difficulty of early diagnosis due to lack of awareness and unavailability or inadequacy of sensitive tests are two of the main challenges for effective case management. Furthermore, the absence of a proper drug for treatment and lack of knowledge about vector biology, distribution, taxonomy and bionomics, and reservoir hosts make the problem serious. The evident potential for visceralization in the cutaneous variant of L. donovani in Sri Lanka may also complicate the issue. Lack of knowledge among local communities also reduces the effectiveness of vector and reservoir host control programs. Immediate actions need to be taken in order to increase scientific knowledge about the disease and a higher effectiveness of the patient management and control programs must be achieved through increased awareness about the disease among general public and active participation of local community in control activities.

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“…66.7% (10 men/2 women) belong to the age [6,8,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30].…”

Section: Gender and Agementioning

confidence: 99%

“…Globally, 36.9 million people living with HIV with 2.0 million new infections per year [31]. 35 countries currently report cases of co infection (Leishmania/HIV) in in 2-12% of all cases of VL, This proportion increases dramatically [16].…”

Section: Diagnosis Of Leishmaniasis In Hiv-infected Patientmentioning

confidence: 99%