title: Treatment outcomes and risk factors for relapse in patients with early-stage human African trypanosomiasis (HAT) in the Republic of the Congo.
abstract: OBJECTIVE
  In 2002-03, the Republic of the Congo increased the threshold separating stage 1 and 2 cases of human African trypanosomiasis (HAT) from a cerebrospinal fluid (CSF) white cell count of 5 cells/mm(3) to 10 cells/mm(3). We aimed to assess whether the increased threshold of 10 cells/mm(3) is a safe indicator of stage 2 disease.
  
  
  METHODS
  We assessed patients treated for stage 1 HAT caused by Trypanosoma brucei gambiense in the Republic of the Congo between April 2001 and April 2005. Patients with 0-10 cells/mm(3) in CSF were classed as stage 1 and treated with pentamidine. Patients with CSF of > 10 cells/mm(3) were classed as stage 2 and treated with either melarsoprol or eflornithine. We did a retrospective analysis of all patients treated after the September 2002 increase in threshold for classification of HAT disease stage 2, and who were eligible for at least 1 year of follow-up. Primary outcome was survival without death or relapse within 1 year of discharge. Risk factors for treatment failure, in particular CSF white cell count on diagnosis, were assessed.
  
  
  RESULTS
  Between September 2002 to April 2004, 692 patients eligible for our analysis were treated with pentamidine. All were discharged alive. Relapse rate was 5% (n = 33). The only identified risk factor for relapse was a CSF white cell count of 6-10 cells/mm(3) rather than 0-5 cells/mm(3) (adjusted hazard ratio 3.27 (95% confidence interval, 1.52-7.01); P = 0.002).
  
  
  CONCLUSIONS
  A threshold of 5 white cells/mm(3) in CSF is safer than 10 cells/mm(3) to determine stage 2 HAT and reduce risk of relapse.
authors.affiliation: Medecins Sans Frontieres, London, England. manica.balasigaram@london.msf.org
authors.forename: Manica
authors.initials: M
authors.lastname: Balasegaram
authors.forename: Steve
authors.initials: S
authors.lastname: Harris
authors.forename: Francesco
authors.initials: F
authors.lastname: Checchi
authors.forename: Catherine
authors.initials: C
authors.lastname: Hamel
authors.forename: Unni
authors.initials: U
authors.lastname: Karunakara
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D002648:Child; D015331:Cohort Studies; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D018450:Disease Progression; D000518:Eflornithine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D010419:Pentamidine / Q000008:administration & dosage / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D014344:Trypanocidal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D014347:Trypanosoma brucei gambiense / Q000187:drug effects*; D014353:Trypanosomiasis, African / Q000188:drug therapy* / Q000453:epidemiology / Q000469:parasitology
chemical_list: D014344:Trypanocidal Agents; D010419:Pentamidine; D000518:Eflornithine