Nobody wants to be bitten by a mosquito and then contract a horrible disease called aEUR” visceral Leishmaniasis.
It can lead to anemia, weight loss, swelling of the liver and spleen, as well as fever. VL, as it’s also known, can be fatal if left untreated. It is one of three types Leishmaniases that are spread by Leishmania, a protozoan parasite. It’s the most dangerous.
“If you don’t get the treatment, you’re almost always going to die,” Dr. Fabiana Alves (director of the leishmaniasis cluster, Drugs for Neglected Diseases Initiative) says.
VL can be even more severe for patients whose immune systems have been affected by HIV. This is because VL treatments that are currently available don’t work well. A significant number of HIV-positive patients live in areas of the world with high levels of VL, such as eastern Africa and Southeast Asia.
Alves notes that “in Ethiopia, between 15 to 20% of patients [roughly 55,000 per year] who have VL are going be co-infected with HIV [with HIV]”. These patients are extremely difficult to treat.
The World Health Organization (AEUR) has now recommended a highly effective treatment that combines two drugs.
The treatment of co-infections was ineffective and unpleasant. Only 55% of those who received treatment survived.
An antifungal drug called amphotericinB was used in the old treatments. This caused serious side effects including rapid kidney damage. The development of a liposomal system to deliver amphotericinB in a bubble of fat molecules improved the drug’s absorption and toxicity. This treatment became the standard in 2010.
These were extremely toxic treatments. Dr. Alves notes. Dr. Alves notes that “we were experiencing a number of cases which were not responding well.”
The combination of oral miltefosine and injected liposomal amphotericin B (LAmB), an antimicrobial drug originally designed to combat cancer, is the new treatment.
The Drugs for Neglected Diseases Initiative aEUR” DNDi aEUR” conducted the study on the effectiveness of the new treatment in Ethiopia starting in 2014. Doctors without Borders began the study in India in 2017 with DNDi’s support.
This combination treatment provides a modest, but significant increase in survival rates to those who have not been coinfected with HIV. It is 88% to 96% higher than LAmB alone. This combination treatment is a significant improvement in efficacy for HIV-infected patients, with survival rates increasing from 55% up to 88%.
Patients will find the new treatment easier to follow aEUR” and more affordable. “When they combine with miltefosine they are seeing that they don’t need as many doses of high-cost drugs,” says Dr. Diego Lins Guedes from Brazil, a physician and professor at Federal University of Pernambuco. He was not involved in the creation of the new treatment.
Another problem was caused by the length of the previous treatment: Patients could be symptomatic, but then relapse and need further treatment.
Vitoria says that relapses are very common due to the strong interaction HIV and leishmaniasis have.
Relapses can also occur because of the time-consuming and difficult old treatment. VL can remain undetected in patients who have not completed the entire treatment.
Guedes says that although relapse is most common within 6 months of treatment, it can occur up to one year after treatment.
Patients who are not symptomatic but have VL parasites can be a problem.
Guedes explains, “They call [those] silent carriers.” They may still be carrying the disease-causing parasite, even though they aren’t showing any symptoms. Sandflies can spread VL to others by biting asymptomatic carriers. VL spread can be slowed down by improving the treatment of people who are already symptomatic.
The new guidelines indicate that VL and HIV coinfections can now be treated more effectively, but there’s still much to do to control these diseases.
In areas where coinfection is prevalent, the new treatment isn’t yet available. Alves says, “We are working closely with ministers of healthcare because now we have to translate this into accessibility.” “These new treatments require that health workers who deal with patients are trained to provide these services.”
Guedes says that South America, particularly Brazil, doesn’t have access miltefosine. Guedes explained that patients will not be able to access miltefosine until they have better access.
Patients must see a healthcare worker each day as the LAmB drug can be administered via injection. It is much simpler to give patients a pill to take than to have to monitor their progress. The Wellcome foundation awarded $5.8 million to DNDi to help continue developing oral treatments for leishmaniasis.
WHO will continue to work on improved treatment programs for HIV co-infection and VL in order to improve survival rates. These improved treatments are one of the WHO’s goals for neglected tropical diseases by 2030.
