Journal Article

A Comparison of Miltefosine and Sodium Stibogluconate for Treatment of Visceral Leishmaniasis in an Ethiopian Population with High Prevalence of HIV Infection

Hundie, Tadesse Beyene, Dejenie, Abren, den Boer, Margriet, Mesure, Jo, Assefa, Yibeltal, Ritmeijer, Koert, Boots, Gerry, Davidson, Robert N.

2006

Overview

Background. Antimonials are the mainstay of visceral leishmaniasis (VL) treatment in Africa. The increasing incidence of human immunodeficiency virus (HIV) coinfection requires alternative safe and effective drug regimens. Oral miltefosine has been proven to be safe and effective in the treatment of Indian VL but has not been studied in Africa or in persons with HIV and VL coinfection. Methods. We compared the efficacy of miltefosine and sodium stibogluconate (SSG) in the treatment of VL in persons in Ethiopia. A total of 580 men with parasitologically and/or serologically confirmed VL were randomized to receive either oral miltefosine (100 mg per day for 28 days) or intramuscular SSG (20 mg/kg per day for 30 days). Results. The initial cure rate was 88% in both treatment groups. Mortality during treatment was 2% in the miltefosine group, compared with 10% in the SSG group. Initial treatment failure was 8% in the miltefosine group, compared with 1% in the SSG group. Among the 375 patients (65%) who agreed to HIV testing, HIV seroprevalence was 29%. Among patients not infected with HIV, initial cure, mortality, and initial treatment failure rates were not significantly different (94% vs. 95%, 1% vs. 3%, and 5% vs. 1% for the miltefosine and SSG groups, respectively). Initial treatment failure with miltefosine occurred in 18% of HIV-coinfected patients, compared with treatment failure in 5% of non–HIV-infected patients. At 6 months after treatment, 174 (60%) of the 290 miltefosine recipients and 189 (65%) of the 290 SSG recipients experienced cure; 30 (10%) of 290 in the miltefosine group and 7 (2%) of 290 in the SSG group experienced relapse, and the mortality rate was 6% in the miltefosine group, compared with 12% in the SSG group. HIV-infected patients had higher rates of relapse (16 [25%] of 63 patients), compared with non–HIV-infected patients (5 [5%] of 131). Conclusions. Treatment with miltefosine is equally effective as standard SSG treatment in non–HIV-infected men with VL. Among HIV-coinfected patients, miltefosine is safer but less effective than SSG.

• Publisher: The University of Chicago Press,University of Chicago Press,Oxford University Press
• Subject: Adult / Antibiotics. Antiinfectious agents. Antiparasitic agents / Antimony Sodium Gluconate - therapeutic use / Antiparasitic agents / Antiprotozoal Agents - therapeutic use / Biological and medical sciences / Coinfection / Comorbidity / Disease control / Drug therapy / Ethiopia - epidemiology / Health outcomes / HIV / HIV Infections - epidemiology / HIV/AIDS / Human immunodeficiency virus / Human protozoal diseases / Human viral diseases / Humans / Infectious diseases / Leishmaniasis, Visceral - drug therapy / Leishmaniasis, Visceral - epidemiology / Leshmaniasis / Male / Medical cures / Medical sciences / Medical treatment failures / Mortality / Parasitic diseases / Pharmacology. Drug treatments / Phosphorylcholine - analogs & derivatives / Phosphorylcholine - therapeutic use / Prevalence / Protozoal diseases / Public health / Relapse / Sodium / Spleen / Treatment Outcome / Vector-borne diseases / Viral diseases / Viral diseases of the lymphoid tissue and the blood. Aids / Visceral leishmaniasis