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dc.contributor.authorvan Griensven, Johan
dc.contributor.authorDiro, Ermias
dc.contributor.authorLopez-Velez, Rogelio
dc.contributor.authorRitmeijer, Koert
dc.contributor.authorBoelaert, Marleen
dc.contributor.authorZijlstra, Ed E
dc.contributor.authorHailu, Asrat
dc.contributor.authorLynen, Lutgarde
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.
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
refterms.dateFOA2019-03-04T11:22:49Z
html.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.


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