A Screen-and-Treat Strategy Targeting Visceral Leishmaniasis in HIV-Infected Individuals in Endemic East African Countries: The Way Forward?

Hdl Handle:
http://hdl.handle.net/10144/325176
Title:
A Screen-and-Treat Strategy Targeting Visceral Leishmaniasis in HIV-Infected Individuals in Endemic East African Countries: The Way Forward?
Authors:
van Griensven, Johan; Diro, Ermias; Lopez-Velez, Rogelio; Ritmeijer, Koert; Boelaert, Marleen; Zijlstra, Ed E; Hailu, Asrat; Lynen, Lutgarde
Journal:
PLoS Neglected Tropical Diseases
Abstract:
In the wake of the HIV epidemic, visceral leishmaniasis (VL), a disseminated protozoan infection caused by the Leishmania donovani complex, has been re-emerging, particularly in North Ethiopia where up to 40% of patients with VL are co-infected with HIV. Management of VL in HIV co-infection is complicated by increased drug toxicity, and high treatment failure and relapse rates with all currently available drugs, despite initiation of antiretroviral treatment. Tackling L. donovani infection before disease onset would thus be a logical approach. A screen-and-treat approach targeting latent or the early stage of infection has successfully been implemented in other HIV-associated opportunistic infections. While conceptually attractive in the context of VL-HIV, the basic understanding and evidence underpinning such an approach is currently lacking. Prospective cohort studies will have to be conducted to quantify the risk of VL in different risk groups and across CD4 cell count levels. This will allow developing clinical prognostic tools, integrating clinical, HIV and Leishmania infection markers. Interventional studies will be needed to evaluate prophylactic or pre-emptive treatment strategies for those at risk, ideally relying on an oral (combination) regimen. Issues like tolerability, emergence of resistance and drug interactions will require due attention. The need for maintenance therapy will have to be assessed. Based on the risk-benefit data, VL risk cut-offs will have to be identified to target treatment to those most likely to benefit. Such a strategy should be complemented with early initiation of antiretroviral treatment and other strategies to prevent HIV and Leishmania infection.
Publisher:
Public Library of Science
Issue Date:
7-Aug-2014
URI:
http://hdl.handle.net/10144/325176
DOI:
10.1371/journal.pntd.0003011
PubMed ID:
25101627
Language:
en
ISSN:
1935-2735
Appears in Collections:
Leishmaniasis/Kala Azar

Full metadata record

DC FieldValue Language
dc.contributor.authorvan Griensven, Johanen_GB
dc.contributor.authorDiro, Ermiasen_GB
dc.contributor.authorLopez-Velez, Rogelioen_GB
dc.contributor.authorRitmeijer, Koerten_GB
dc.contributor.authorBoelaert, Marleenen_GB
dc.contributor.authorZijlstra, Ed Een_GB
dc.contributor.authorHailu, Asraten_GB
dc.contributor.authorLynen, Lutgardeen_GB
dc.date.accessioned2014-08-25T16:36:19Z-
dc.date.available2014-08-25T16:36:19Z-
dc.date.issued2014-08-07-
dc.identifier.citationA Screen-and-Treat Strategy Targeting Visceral Leishmaniasis in HIV-Infected Individuals in Endemic East African Countries: The Way Forward? 2014, 8 (8):e3011 PLoS Negl Trop Disen_GB
dc.identifier.issn1935-2735-
dc.identifier.pmid25101627-
dc.identifier.doi10.1371/journal.pntd.0003011-
dc.identifier.urihttp://hdl.handle.net/10144/325176-
dc.description.abstractIn the wake of the HIV epidemic, visceral leishmaniasis (VL), a disseminated protozoan infection caused by the Leishmania donovani complex, has been re-emerging, particularly in North Ethiopia where up to 40% of patients with VL are co-infected with HIV. Management of VL in HIV co-infection is complicated by increased drug toxicity, and high treatment failure and relapse rates with all currently available drugs, despite initiation of antiretroviral treatment. Tackling L. donovani infection before disease onset would thus be a logical approach. A screen-and-treat approach targeting latent or the early stage of infection has successfully been implemented in other HIV-associated opportunistic infections. While conceptually attractive in the context of VL-HIV, the basic understanding and evidence underpinning such an approach is currently lacking. Prospective cohort studies will have to be conducted to quantify the risk of VL in different risk groups and across CD4 cell count levels. This will allow developing clinical prognostic tools, integrating clinical, HIV and Leishmania infection markers. Interventional studies will be needed to evaluate prophylactic or pre-emptive treatment strategies for those at risk, ideally relying on an oral (combination) regimen. Issues like tolerability, emergence of resistance and drug interactions will require due attention. The need for maintenance therapy will have to be assessed. Based on the risk-benefit data, VL risk cut-offs will have to be identified to target treatment to those most likely to benefit. Such a strategy should be complemented with early initiation of antiretroviral treatment and other strategies to prevent HIV and Leishmania infection.en_GB
dc.languageENG-
dc.language.isoenen
dc.publisherPublic Library of Scienceen_GB
dc.rightsArchived with thanks to PLoS Neglected Tropical Diseasesen_GB
dc.subjectvisceral leishmaniasisen_GB
dc.subjectHIVen_GB
dc.titleA Screen-and-Treat Strategy Targeting Visceral Leishmaniasis in HIV-Infected Individuals in Endemic East African Countries: The Way Forward?en
dc.identifier.journalPLoS Neglected Tropical Diseasesen_GB

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