High parasitological failure rate of visceral leishmaniasis to sodium stibogluconate among HIV co-infected adults in Ethiopia.
High parasitological failure rate of visceral leishmaniasis to sodium stibogluconate among HIV co-infected adults in Ethiopia.
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DOI：
10.1371/journal.pntd.0002875
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发表时间：
2014-05
影响因子：
3.8
通讯作者：
van Griensven J
中科院分区：
文献类型：
--
作者：
Diro E;Lynen L;Mohammed R;Boelaert M;Hailu A;van Griensven J
在东非，由于缺乏更安全的替代药物，如脂质体利什曼菌素B，锑剂仍被用于治疗HIV合并感染患者的内脏利什曼病（VL）。除了耐受性，锑剂耐药性的出现也是一个主要问题。本研究旨在评估VL-HIV合并感染患者接受葡萄糖酸锑钠（SSG）治疗的临床结局。对在埃塞俄比亚西北部的一个临床试验地点接受治疗的VL-HIV合并感染患者进行了回顾性病历分析。纳入了经寄生虫学证实的VL和HIV合并感染的患者，这些患者接受了SSG治疗。SSG的剂量为20 mg Sb 5（五价锑）/kg，最大剂量为850 mg Sb 5，持续30天。根据组织抽吸结果将临床结局定义为治愈或失败，并计算安全性和死亡率。该研究包括57名接受SSG治疗的患者，到治疗结束时，只有43.9%的患者治愈。寄生虫病治疗失败率为31.6%，病死率为14.0%。12例（21.1%）病例因安全性问题暂时或永久停用SSG。高基线寄生虫负荷（分级超过4+）与治疗失败显著相关（比值比= 8.9，95%置信区间= 0.5 -51.7）。 SSG不仅不安全，而且对VL-HIV患者的有效性低。安全有效的替代药物是非常迫切需要的。应在该区域开展药物敏感性监测。VL和HIV的共感染是一个非常具有挑战性的临床问题，特别是在东非地区。虽然脂质体阿替霉素B是推荐的VL-HIV合并感染的治疗选择，但在埃塞俄比亚实践中通常无法获得。因此，一些患者仍然在接受锑剂治疗，这些锑剂因其毒性而臭名昭著。在这项研究中，我们描述了一系列的57例患者的锑治疗的结果。锑剂的有效性被认为是低的，与以前的研究相比，下降。迫切需要确保提供更安全和更有效的VL-HIV替代药物。这似乎也是明智的，开始监测计划的药物敏感性利什曼原虫，因为我们的结果可能涉及到新出现的锑耐药性在东非地区。
Antimonials are still being used for visceral leishmaniasis (VL) treatment among HIV co-infected patients in East-Africa due to the shortage of alternative safer drugs like liposomal amphotericin B. Besides tolerability, emergence of resistance to antimonials is a major concern. This study was aimed at assessing the clinical outcome of VL-HIV co-infected patients when treated with sodium stibogluconate (SSG). Retrospective patient record analysis of VL-HIV co-infected patients treated at a clinical trial site in north-west Ethiopia was done. Patients with parasitologically confirmed VL and HIV co-infection treated with SSG were included. The dose of SSG used was 20 mg Sb5 (pentavalent antimony)/kg and maximum of 850 mg Sb5 for 30 days. The clinical outcomes were defined based on the tissue aspiration results as cure or failure, and additionally the safety and mortality rates were computed. The study included 57 patients treated with SSG and by the end of treatment only 43.9% of patients were cured. The parasitological treatment failure and the case fatality rate were 31.6% and 14.0% respectively. SSG was discontinued temporarily or permanently for 12 (21.1%) cases due to safety issues. High baseline parasite load (graded more than 4+) was significantly associated with treatment failure (odds ratio = 8.9, 95% confidence interval = .5-51.7). SSG is not only unsafe, but also has low effectiveness for VL-HIV patients. Safe and effective alternative medications are very urgently needed. Drug sensitivity surveillance should be introduced in the region. The co-infection of VL and HIV is a very challenging clinical problem especially in the East-Africa region. Though liposomal amphotericin B is the recommended treatment option for VL-HIV co-infection, it is often not available in practice in Ethiopia. Thus several patients are still being treated with antimonials that are infamous for their toxicity. In this study, we describe the results of such antimonial treatment in a series of 57 patients. The effectiveness of antimonials was found to be low and, in comparison to previous studies, declining. There is an urgent need to assure the availability of safer and more effective alternative medications for VL-HIV. It seems also wise to start a surveillance scheme for drug susceptibility in leishmania parasites as our results may relate to emerging antimonial resistance in the East-Africa region.
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DOI：
10.1016/j.trstmh.2010.07.007
发表时间：
2010-11-01
影响因子：
2.2
作者：
Hailu, Workagegnehu;Weldegebreal, Teklu;Hailu, Asrat
通讯作者：
Hailu, Asrat
影响因子：
168.9
作者：
Liese, Bernhard;Rosenberg, Mark;Schratz, Alexander
通讯作者：
Schratz, Alexander
影响因子：
--
作者：
Khalil, EAG;El Hassan, AM;Ali, MS
通讯作者：
Ali, MS
影响因子：
3.8
作者：
Hotez PJ;Kamath A
通讯作者：
Kamath A
影响因子：
1.6
作者：
Chakravarty J;Sundar S
通讯作者：
Sundar S