Alarm over rising co-infection of HIV and parasitic killer kala-azar

Scientists are concerned over the rising number of cases of kala-azar, a parasitic disease spread by sandfly bites, among people living with HIV.

Scientists are concerned over the rising number of cases of kala-azar, a parasitic disease spread by sandfly bites, among people living with HIV.

Kala-azar, known medically as visceral leishmaniasis (VL), is nearly always fatal if left untreated. Recent research indicates that VL-HIV co-infection is a growing global problem, with the emerging trend being reported in 35 countries worldwide. Scientists shared these findings at the Leishmaniasis East Africa Platform scientific conference in Bahir Dar, Ethiopia, held from 29 September to 2 October.

East Africa is one of the regions in the world hardest hit by the co-infection, where HIV is detected in up to 40 per cent of patients infected with VL.

Higher risk

“It is an emerging problem where people living with HIV are at a higher risk of developing severe visceral leishmaniasis,” says Dr Natalie Strub-Wourgaft, of Drugs for Neglected Disease Initiative (DNDi), Switzerland.

According to Dr Strub-Wourgaft, the movement of people living with HIV from urban to rural areas exposes them to sandfly bites, which breed in the villages. This also means VL-HIV co-infection is common among migrant populations of people aged between 20 and 30.

Medics say VL-HIV co-infection is proving difficult to treat because of the possibility of repeat infection with visceral leishmaniasis, even after a patient has been cured of the disease.

“The co-infection is a real threat to a patient’s life because visceral leishmaniasis can kill if not treated early,” says Dr Strub-Wourgaft.

Search for treatment

The scientific community’s intellectual might will be put to test in the next few months as an ongoing research searches for new treatment for VL-HIV co-infection.

The research team at Gondar University Hospital in Ethiopia expects to table its final results in the next two years, where trials with two drug regimens look promising, medics say.

Ambisome, a drug that has been effective in treating VL in India, is being tested, but medics say that a combination of this drug with another could pull off new breakthroughs.

“We want to achieve an initial cure by providing very aggressive treatment, which we do not do for patients infected with visceral leishmaniasis, but who are HIV negative,” says Professor Asrat Hailu Mekuria of the Addis Ababa University, Ethiopia. “We will do this by combining two or more drugs.”

Danger of relapse

However, according to Professor Mekuria, even with an initial cure, people living with HIV are faced with the possibility of a relapse or repeat infection.

“To prevent relapse we will do another clinical trial,” says Professor Mekuria. “It is a two-pronged approach aiming to achieve initial cure using aggressive treatment and then preventing relapses.”

The current treatment for VL can take up to a month while a patient is admitted in hospital. The cost of treatment is estimated at US$390 for every household.

Currently, DNDi and other development partners work with governments to cover treatment costs, because the disease often affects the most vulnerable and marginalised people who cannot afford to pay. “Our focus is to make treatment cheaper,” said Professor Mekuria.

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