[Ip-health] MSF: East African HIV programmes must wake up to visceral leishmaniasis

Joanna Keenan-Siciliano joanna.l.keenan at gmail.com
Fri Dec 9 09:14:16 PST 2011

MSF issued a press release during the week on scaling up treatment of
visceral leishmaniasis (kala azar); please see below with link to briefing

East African HIV programmes must wake up to visceral leishmaniasis

*With new MSF data showing combination treatments give promising results,
diagnosis and treatment of VL should be scaled up*



*ADDIS ABABA/NAIROBI, 8 December 2011* – Improving the capacities of HIV
programmes to prevent, diagnose and treat visceral leishmaniasis (VL)
should be a priority in East Africa, international medical humanitarian
organisation Médecins Sans Frontières (MSF) said today at the ICASA AIDS
Conference currently being held in the Ethiopian capital Addis Ababa.

Visceral leishmaniasis, also known as ‘kala azar’, is a neglected parasitic
disease spread through the bite of a sandfly. Visceral leishmaniasis is
endemic in 76 countries worldwide. In East Africa, regions in Ethiopia,
Kenya, Sudan and South Sudan are particularly affected. The disease is
fatal without treatment.

“People living with HIV are particularly vulnerable, so it’s critical that
HIV programmes kick start a response to this neglected disease,” said Dr.
Rachel ter Horst, medical advocacy advisor with MSF, who presented MSF
field experience and research on the management of HIV/VL co-infection at
ICASA. “In countries like Ethiopia where HIV and visceral leishmaniasis
interact and co-infection is a problem, HIV programmes are essentially
faced with the same paradigm as with tuberculosis. HIV programmes have
learnt to think TB – they also need to learn to think visceral

North-western Ethiopia has the highest burden of HIV/VL co-infection, as
around one in three patients with visceral leishmaniasis is also

Visceral leishmaniasis interacts with HIV in many ways. People living with
HIV are at much higher risk to develop this disease. Visceral leishmaniasis
accelerates progression to AIDS. Relapses are almost inevitable in people
living with HIV and HIV-positive patients respond less well to
anti-leishmanial treatment with each subsequent relapse. But successful
treatment of the first episode of visceral leishmaniasis and early
initiation of antiretroviral therapy may delay and reduce relapses.

“As a first step, HIV programmes in areas that are endemic for visceral
leishmaniasis should actively screen people living with HIV for this
life-threatening disease,” said Dr. Ter Horst. “Co-infected patients should
then be given antiretrovirals as soon as possible after starting
anti-leishmanial therapy.”

New data presented at ICASA by MSF suggests that the use of high-dose
combination treatment regimens for co-infected patients can improve
survival in the longer-term: early results suggest that treatment with
liposomal amphotericin B at higher doses, combined with miltefosine, may
have higher safety and efficacy than other options.

“Until now, treating people living with HIV who also suffer from visceral
leishmaniasis has led to pretty bleak outcomes,” said Dr. Koert Ritmeijer,
MSF health advisor. “Existing treatments were failing – some like SSG are
too toxic and lead to high mortality in co-infected patients, others like
liposomal amphotericin B are safe but aren’t effective enough.  We’re now
seeing high-dose combination therapies have led to better initial cure
rates, including in patients who had been cured of VL but have since
suffered a relapse.”

Two clinical trials co-sponsored by MSF, the Drugs for Neglected Diseases
initiative (DNDi), and the Institute of Tropical Medicine in Antwerp (ITM),
and in collaboration with Gondar University in Ethiopia, will be
implemented in 2012, both to confirm these promising results and to
investigate the benefits of preventive therapy to reduce the occurrence of

“With the prospect of better treatment options, if the studies confirm
these results, we hope that improved treatment guidelines will be
implemented throughout the region in the near future,” said Dr. Ritmeijer.
Joanna Keenan
Press Officer
Access Campaign
Medecins Sans Frontieres
E: joanna.keenan[at]geneva.msf.org
T: @joanna_keenan


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