High parasitological failure rate of visceral leishmaniasis to sodium stibogluconate among HIV co-infected adults in Ethiopia.
BACKGROUND
Antimonials are still being used for visceral leishmaniasis (VL) treatment among HIV co-infected patients in East-Africa due to the shortage of alternative safer drugs like liposomal amphotericin B. Besides tolerability, emergence of resistance to antimonials is a major concern.


OBJECTIVE
This study was aimed at assessing the clinical outcome of VL-HIV co-infected patients when treated with sodium stibogluconate (SSG).


METHODS
Retrospective patient record analysis of VL-HIV co-infected patients treated at a clinical trial site in north-west Ethiopia was done. Patients with parasitologically confirmed VL and HIV co-infection treated with SSG were included. The dose of SSG used was 20 mg Sb5 (pentavalent antimony)/kg and maximum of 850 mg Sb5 for 30 days. The clinical outcomes were defined based on the tissue aspiration results as cure or failure, and additionally the safety and mortality rates were computed.


RESULTS
The study included 57 patients treated with SSG and by the end of treatment only 43.9% of patients were cured. The parasitological treatment failure and the case fatality rate were 31.6% and 14.0% respectively. SSG was discontinued temporarily or permanently for 12 (21.1%) cases due to safety issues. High baseline parasite load (graded more than 4+) was significantly associated with treatment failure (odds ratio = 8.9, 95% confidence interval = .5-51.7).


CONCLUSIONS
SSG is not only unsafe, but also has low effectiveness for VL-HIV patients. Safe and effective alternative medications are very urgently needed. Drug sensitivity surveillance should be introduced in the region.
University of Gondar, Gondar, Ethiopia; Institute of Tropical Medicine, Antwerp, Belgium.
Ermias
E
Diro
Institute of Tropical Medicine, Antwerp, Belgium.
Lutgarde
L
Lynen
University of Gondar, Gondar, Ethiopia.
Rezika
R
Mohammed
Institute of Tropical Medicine, Antwerp, Belgium.
Marleen
M
Boelaert
Addis Ababa University School of Medicine, Addis Ababa, Ethiopia.
Asrat
A
Hailu
Institute of Tropical Medicine, Antwerp, Belgium.
Johan
J
van Griensven
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000967:Antimony Sodium Gluconate / Q000627:therapeutic use*; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D060085:Coinfection; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000469:parasitology* / Q000821:virology; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000188:drug therapy* / Q000453:epidemiology / Q000469:parasitology / Q000821:virology*; D008297:Male; D059208:Parasite Load; D012189:Retrospective Studies; D016896:Treatment Outcome
D044966:Anti-Retroviral Agents; D000981:Antiprotozoal Agents; D000967:Antimony Sodium Gluconate