WHO releases new guidelines for the treatment of people co-infected with visceral leishmaniasis and HIV

The previously recommended treatment for VL-HIV coinfection consisted of intermittent daily injections of liposomal amphotericin B (AmBisome) over a period of up to 38 days

The World Health Organization (WHO) has released its new guidelines for the treatment of people co-infected with Visceral Leishmaniasis (VL) and HIV. The new guidelines are based on results of one study conducted in India by Médecins Sans Frontières (MSF) and partners, and another in Ethiopia by the Drugs for Neglected Diseases initiative (DNDi) and partners.

Visceral Leishmaniasis, also known as Kala Azar, is a neglected tropical parasitic disease transmitted by sandflies, causing fever, weight loss and is fatal if left untreated. People living with HIV living in VL endemic areas are 100 to 2,300 times more likely to develop visceral leishmaniasis than those without HIV.

The previously recommended treatment for VL-HIV coinfection consisted of intermittent daily injections of liposomal amphotericin B (AmBisome) over a period of up to 38 days. The new treatment uses a combination of AmBisome and oral miltefosine. This has resulted in significantly better efficacy rates.

Dr Sakib Burza, medical advisor and study coordinator, MSF said, “For the first time, patients with VL-HIV coinfection in India will be treated with an evidence-based treatment. This is an important step towards recognising these patients as highly vulnerable both from a clinical and social perspective; improving their management will benefit both patients and the VL elimination programme. However, there remains a lot to be done; these patients present with multiple complex medical issues that need to be addressed holistically, including a very high prevalence of TB.”

In the Indian study, the new recommended treatment regimen demonstrated 96 per cent efficacy at six months compared to 88 per cent in the previous treatment, crucially with the duration of treatment reducing from five to two weeks. In the Ethiopian study, the new recommended treatment strategy was shown to have an 88 per cent efficacy rate at the end of therapy (after 58 days), whereas efficacy of the current standard treatment was 55 per cent in the trial.

Dr Fabiana Alves, Director, NTD (Neglected Tropical Diseases) Leishmaniasis and Mycetoma, DNDi said, “The new WHO guidelines are a significant step that will greatly improve the lives of patients who are affected by both diseases and who are suffering from stigma, ostracisation, loss of income and repeated relapses.”

In India, the study was financially supported by MSF-Spain, with support from the DNDi and National Vector Borne Disease Control Programme. The study in Ethiopia was financially supported by the European Union, the German Federal Ministry of Education and Research (BMBF) through KfW, MSF International, the Medicor Foundation, Liechtenstein, Spanish Agency for International Development Cooperation and the Swiss Development Cooperation (SDC).