A Screen-and-Treat Strategy Targeting Visceral Leishmaniasis in HIV-Infected Individuals in Endemic East African Countries: The Way Forward?
Name:
van Griensven et al-2014-A Screen ...
Size:
220.3Kb
Format:
PDF
Description:
Main Article
Authors
van Griensven, JohanDiro, Ermias
Lopez-Velez, Rogelio
Ritmeijer, Koert
Boelaert, Marleen
Zijlstra, Ed E
Hailu, Asrat
Lynen, Lutgarde
Issue Date
2014-08-07
Metadata
Show full item recordJournal
PLoS Neglected Tropical DiseasesAbstract
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 SciencePubMed ID
25101627Language
enISSN
1935-2735ae974a485f413a2113503eed53cd6c53
10.1371/journal.pntd.0003011
Scopus Count
Collections
Related articles
- Exploring prognosis in chronic relapsing visceral leishmaniasis among HIV-infected patients: Circulating Leishmania DNA.
- Authors: Cota GF, de Sousa MR, de Assis TSM, Pinto BF, Rabello A
- Issue date: 2017 Aug
- Longitudinal evaluation of asymptomatic Leishmania infection in HIV-infected individuals in North-West Ethiopia: A pilot study.
- Authors: van Griensven J, van Henten S, Mengesha B, Kassa M, Adem E, Endris Seid M, Abdellati S, Asefa W, Simegn T, Debasu D, Bogale T, Gedamu Y, Van Den Bossche D, Adriaensen W, Van der Auwera G, Cnops L, Vogt F, Diro E
- Issue date: 2019 Oct
- Concordant HIV infection and visceral leishmaniasis in Ethiopia: the influence of antiretroviral treatment and other factors on outcome.
- Authors: ter Horst R, Collin SM, Ritmeijer K, Bogale A, Davidson RN
- Issue date: 2008 Jun 1
- High frequency of subclinical Leishmania infection among HIV-infected patients living in the endemic areas of visceral leishmaniasis in Fars province, southern Iran.
- Authors: Rezaei Z, Sarkari B, Dehghani M, Layegh Gigloo A, Afrashteh M
- Issue date: 2018 Aug
- Visceral Leishmaniasis and HIV coinfection in East Africa.
- Authors: Diro E, Lynen L, Ritmeijer K, Boelaert M, Hailu A, van Griensven J
- Issue date: 2014 Jun