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    Apr 19, 2021
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    A Screen-and-Treat Strategy Targeting Visceral Leishmaniasis in HIV-Infected Individuals in Endemic East African Countries: The Way Forward?

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    Name:
    van Griensven et al-2014-A Screen ...
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    Authors
    van Griensven, Johan
    Diro, Ermias
    Lopez-Velez, Rogelio
    Ritmeijer, Koert
    Boelaert, Marleen
    Zijlstra, Ed E
    Hailu, Asrat
    Lynen, Lutgarde
    Issue Date
    2014-08-07
    
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    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
    URI
    http://hdl.handle.net/10144/325176
    DOI
    10.1371/journal.pntd.0003011
    PubMed ID
    25101627
    Language
    en
    ISSN
    1935-2735
    ae974a485f413a2113503eed53cd6c53
    10.1371/journal.pntd.0003011
    Scopus Count
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    Leishmaniasis/Kala Azar

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