Low castes have poor access to visceral leishmaniasis treatment in Bihar, India

Martinez, Fernando; Picado, Albert; Roddy, Paul; Palma, Pedro Pablo

doi:10.1111/j.1365-3156.2012.02960.x

Cited by 26 publications

(17 citation statements)

References 18 publications

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“…VL predominantly affects the poorest strata of society and those with limited access to care [2]. The incidence is estimated to be between 146,700 and 282,800 cases per year [3].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Visceral Leishmaniasis Relapse in Immunocompetent Patients following Treatment with 20 mg/kg Liposomal Amphotericin B (Ambisome) in Bihar, India

Burza¹,

Sinha

Mahajan³

et al. 2014

PLoS Negl Trop Dis

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BackgroundA proportion of all immunocompetent patients treated for visceral leishmaniasis (VL) are known to relapse; however, the risk factors for relapse are not well understood. With the support of the Rajendra Memorial Research Institute (RMRI), Médecins Sans Frontières (MSF) implemented a program in Bihar, India, using intravenous liposomal amphotericin B (Ambisome) as a first-line treatment for VL. The aim of this study was to identify risk factors for VL relapse by examining the characteristics of immunocompetent patients who relapsed following this regimen.Methods and Principal FindingsThis is an observational retrospective cohort study of all VL patients treated by the MSF program from July 2007 to August 2012. Intravenous Ambisome was administered to 8749 patients with VL in four doses of 5 mg/kg (for a total dose of 20 mg/kg) over 4–10 days, depending on the severity of disease. Out of 8588 patients not known to be HIV-positive, 8537 (99.4%) were discharged as initial cures, 24 (0.3%) defaulted, and 27 (0.3%) died during or immediately after treatment. In total, 1.4% (n = 119) of the initial cured patients re-attended the programme with parasitologically confirmed VL relapse, with a median time to relapse of 10.1 months. Male sex, age <5 years and ≥45 years, a decrease in spleen size at time of discharge of ≤0.5 cm/day, and a shorter duration of symptoms prior to seeking treatment were significantly associated with relapse. Spleen size at admission, hemoglobin level, nutritional status, and previous history of relapse were not associated with relapse.ConclusionsThis is the largest cohort of VL patients treated with Ambisome worldwide. The risk factors for relapse included male sex, age <5 and ≥45 years, a smaller decrease in splenomegaly at discharge, and a shorter duration of symptoms prior to seeking treatment. The majority of relapses in this cohort occurred 6–12 months following treatment, suggesting that a 1-year follow-up is appropriate in future studies.

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“…VL predominantly affects the poorest strata of society and those with limited access to care [2]. The incidence is estimated to be between 146,700 and 282,800 cases per year [3].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Visceral Leishmaniasis Relapse in Immunocompetent Patients following Treatment with 20 mg/kg Liposomal Amphotericin B (Ambisome) in Bihar, India

Burza¹,

Sinha

Mahajan³

et al. 2014

PLoS Negl Trop Dis

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“…Some residual confounding cannot be ruled out, but other factors probably play a role. One such factor could be long delays in seeking health care by Musahars, which was documented in another recent study ( 14 ). When devising improved VL control strategies, it would certainly be justified to pay special attention to the hamlets inhabited by the Musahar caste.…”

Section: Discussionmentioning

confidence: 94%

Visceral Leishmaniasis, Rural Bihar, India

Hasker

Singh²,

Malaviya³

et al. 2012

Emerg. Infect. Dis.

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“…In South Asia, it is linked to poor housing and unhealthy living environments [66]. Economic and social exclusion are strong underlying determinants of poor access to VL treatment, as a recent study of low-caste Indians with the disease indicates [67]. Access to timely diagnosis and prompt, effective treatment is hindered by geographical, financial and social obstacles.…”

Section: Expert Opinionmentioning

confidence: 99%

Liposomal amphotericin B as a treatment for human leishmaniasis

Balasegaram

Ritmeijer

Lima

et al. 2012

Expert Opinion on Emerging Drugs

143

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Introduction:Leishmaniasis is a parasitic disease transmitted by phlebotomine sandflies. Between 700,000 and 1.2 million cases of cutaneous leishmaniasis and between 200,000 and 400,000 cases of visceral leishmaniasis (VL), which is fatal if left untreated, occur annually worldwide. Liposomal amphotericin B (LAMB), alone or in combination with other drugs, has been extensively studied as VL treatment, but data on routine field use are limited, and several challenges to patients' access to this life-saving drug remain.Areas covered:This article provides a review of clinical studies on LAMB for VL and other forms of leishmaniasis. The current development of generic versions of LAMB and related challenges are also discussed.Expert opinion:LAMB proved to be highly efficacious and safe in over 8000 VL patients treated by MÉdecins Sans Frontières in South Asia, and its use was feasible even at primary healthcare level. Despite requiring higher doses, LAMB is the drug of choice to treat vulnerable groups (e.g., pregnant or HIV positive) and relapsing VL patients in East Africa. LAMB should be included in national VL guidelines and registered in all VL endemic countries. Its cost should be further reduced and regulatory pathways to prove bioequivalence for generic LAMB products should be implemented.

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Low castes have poor access to visceral leishmaniasis treatment in Bihar, India

Cited by 26 publications

References 18 publications

Risk Factors for Visceral Leishmaniasis Relapse in Immunocompetent Patients following Treatment with 20 mg/kg Liposomal Amphotericin B (Ambisome) in Bihar, India

Risk Factors for Visceral Leishmaniasis Relapse in Immunocompetent Patients following Treatment with 20 mg/kg Liposomal Amphotericin B (Ambisome) in Bihar, India

Visceral Leishmaniasis, Rural Bihar, India

Liposomal amphotericin B as a treatment for human leishmaniasis

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