Hope for the co-infected with HIV and killer parasitic disease

The search for new treatment for patients co-infected with HIV and kala-azar is in its early stages, but researchers are certain a drug to treat the condition could be found in 2015.

The search for new treatment for patients co-infected with HIV and kala-azar is in its early stages, but researchers are certain a drug to treat the condition could be found in 2015.

Kala-azar, known medically as visceral leishmaniasis, is a parasitic disease transmitted by sandfly bites. It attacks the immune system and is usually fatal if left untreated.

Research at the Gondar University clinic in Ethiopia, where trials are underway, is showing promise, researchers say. The phase III clinical study is assessing the possibility of developing treatment for patients co-infected with HIV and kala-azar through two trials.

The first is a combination treatment of the drugs Ambisome and Miltefosine, while the second hopes to develop treatment from Ambisome alone, according to Dr Ermias Diro, a lead researcher at the University.

“We expect to have final results of the study in the next year,” says Dr Diro. “They will be used to develop treatment guidelines in countries which are affected with HIV and kala-azar co-infection.”

Migrants most at risk

Medics are concerned about the interaction between HIV and kala-azar, with many becoming increasingly worried about the difficulties in treating people who are co-infected.

Initial studies indicate that co-infection is prevalent among migrant workers. For instance, in Ethiopia, it has been proved that the condition is common among populations that migrate to look for work in the lowlands. This is where the sandfly, the vector that transmits kala-azar, is known to breed.

“In the past it used to be military personnel who were at risk of HIV infection but recently it is the migrant workers,” said Professor Asrat Hailu Mekuria, from Addis Ababa University. “When they are exposed to sandfly bites they acquire kala-azar. Then they are exposed to HIV through extra marital sex.”

Relapse makes treatment difficult

According to Professor Mekuria, it is easy to treat kala-azar when patients are HIV negative, but when they are co-infected, they require prolonged treatment. The success of the treatment is uncertain due to the possibility of a relapse of kala-azar.

Tesfaye Tebebe (not his real name), a patient receiving treatment at the Gondar University clinic, is co-infected with HIV and kala-azar. He knows the pain of the condition.

“When I started treatment for kala-azar I was already on antiretroviral therapy,” says the 40-year-old. “From the start of the kala-azar treatment, I was feeling discomfort and loss of sleep.” It is such difficulties that the study hopes to solve.

The Drugs for Neglected Diseases Initiative (DNDI) says the study is running trials with 66 patients for each of the two treatment options in Ethiopia, which means 132 patients are participating.

“The reason we are doing this study here is because this is where the patients are at most in need of these new treatments,” said Dr Fabiana Alves, clinical project manager at DNDI. “This is where we can find majority of patients affected by the two infections.”

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