Visceral leishmaniasis and HIV co-infection in Bihar, India: long-term effectiveness and treatment outcomes with liposomal amphotericin B (AmBisome).
BACKGROUND:Visceral Leishmaniasis (VL; also known as kala-azar) is an ultimately fatal disease endemic in the Indian state of Bihar, while HIV/AIDS is an emerging disease in this region. A 2011 observational cohort study conducted in Bihar involving 55 VL/HIV co-infected patients treated with 20-25...
Published in: | PLoS Neglected Tropical Diseases |
---|---|
Main Authors: | , , , , , , , , , , , , |
Format: | Article in Journal/Newspaper |
Language: | English |
Published: |
Public Library of Science (PLoS)
2014
|
Subjects: | |
Online Access: | https://doi.org/10.1371/journal.pntd.0003053 https://doaj.org/article/d33fc12178744f9ea6e5fafe3dbd1bda |
id |
ftdoajarticles:oai:doaj.org/article:d33fc12178744f9ea6e5fafe3dbd1bda |
---|---|
record_format |
openpolar |
spelling |
ftdoajarticles:oai:doaj.org/article:d33fc12178744f9ea6e5fafe3dbd1bda 2023-05-15T15:17:44+02:00 Visceral leishmaniasis and HIV co-infection in Bihar, India: long-term effectiveness and treatment outcomes with liposomal amphotericin B (AmBisome). Sakib Burza Raman Mahajan Prabhat K Sinha Johan van Griensven Krishna Pandey María Angeles Lima Marta Gonzalez Sanz Temmy Sunyoto Sunil Kumar Gaurab Mitra Ranjeet Kumar Neena Verma Pradeep Das 2014-08-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0003053 https://doaj.org/article/d33fc12178744f9ea6e5fafe3dbd1bda EN eng Public Library of Science (PLoS) http://europepmc.org/articles/PMC4125300?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0003053 https://doaj.org/article/d33fc12178744f9ea6e5fafe3dbd1bda PLoS Neglected Tropical Diseases, Vol 8, Iss 8, p e3053 (2014) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2014 ftdoajarticles https://doi.org/10.1371/journal.pntd.0003053 2022-12-31T01:36:33Z BACKGROUND:Visceral Leishmaniasis (VL; also known as kala-azar) is an ultimately fatal disease endemic in the Indian state of Bihar, while HIV/AIDS is an emerging disease in this region. A 2011 observational cohort study conducted in Bihar involving 55 VL/HIV co-infected patients treated with 20-25 mg/kg intravenous liposomal amphotericin B (AmBisome) estimated an 85.5% probability of survival and a 26.5% probability of VL relapse within 2 years. Here we report the long-term field outcomes of a larger cohort of co-infected patients treated with this regimen between 2007 and 2012. METHODS AND PRINCIPAL FINDINGS:Intravenous AmBisome (20-25 mg/kg) was administered to 159 VL/HIV co-infected patients (both primary infections and relapses) in four or five doses of 5 mg/kg over 4-10 days. Initial cure of VL at discharge was defined as improved symptoms, cessation of fever, improvement of appetite and recession of spleen enlargement. Test of cure was not routinely performed. Antiretroviral treatment (ART) was initiated in 23 (14.5%), 39 (24.5%) and 61 (38.4%) before, during and after admission respectively. Initial cure was achieved in all discharged patients. A total of 36 patients died during follow-up, including six who died shortly after admission. Death occurred at a median of 11 weeks (IQR 4-51) after starting VL treatment. Estimated mortality risk was 14.3% at six months, 22.4% at two years and 29.7% at four years after treatment. Among the 153 patients discharged from the hospital, 26 cases of VL relapse were diagnosed during follow-up, occurring at a median of 10 months (IQR 7-14) after discharge. After accounting for competing risks, the estimated risk of relapse was 16.1% at one year, 20.4% at two years and 25.9% at four years. Low hemoglobin level and concurrent infection with tuberculosis were independent risk factors for mortality, while ART initiated shortly after admission for VL treatment was associated with a 64-66% reduced risk of mortality and 75% reduced risk of relapse. SIGNIFICANCE:This is the ... Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Indian Azar ENVELOPE(-63.733,-63.733,-64.983,-64.983) PLoS Neglected Tropical Diseases 8 8 e3053 |
institution |
Open Polar |
collection |
Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Sakib Burza Raman Mahajan Prabhat K Sinha Johan van Griensven Krishna Pandey María Angeles Lima Marta Gonzalez Sanz Temmy Sunyoto Sunil Kumar Gaurab Mitra Ranjeet Kumar Neena Verma Pradeep Das Visceral leishmaniasis and HIV co-infection in Bihar, India: long-term effectiveness and treatment outcomes with liposomal amphotericin B (AmBisome). |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
BACKGROUND:Visceral Leishmaniasis (VL; also known as kala-azar) is an ultimately fatal disease endemic in the Indian state of Bihar, while HIV/AIDS is an emerging disease in this region. A 2011 observational cohort study conducted in Bihar involving 55 VL/HIV co-infected patients treated with 20-25 mg/kg intravenous liposomal amphotericin B (AmBisome) estimated an 85.5% probability of survival and a 26.5% probability of VL relapse within 2 years. Here we report the long-term field outcomes of a larger cohort of co-infected patients treated with this regimen between 2007 and 2012. METHODS AND PRINCIPAL FINDINGS:Intravenous AmBisome (20-25 mg/kg) was administered to 159 VL/HIV co-infected patients (both primary infections and relapses) in four or five doses of 5 mg/kg over 4-10 days. Initial cure of VL at discharge was defined as improved symptoms, cessation of fever, improvement of appetite and recession of spleen enlargement. Test of cure was not routinely performed. Antiretroviral treatment (ART) was initiated in 23 (14.5%), 39 (24.5%) and 61 (38.4%) before, during and after admission respectively. Initial cure was achieved in all discharged patients. A total of 36 patients died during follow-up, including six who died shortly after admission. Death occurred at a median of 11 weeks (IQR 4-51) after starting VL treatment. Estimated mortality risk was 14.3% at six months, 22.4% at two years and 29.7% at four years after treatment. Among the 153 patients discharged from the hospital, 26 cases of VL relapse were diagnosed during follow-up, occurring at a median of 10 months (IQR 7-14) after discharge. After accounting for competing risks, the estimated risk of relapse was 16.1% at one year, 20.4% at two years and 25.9% at four years. Low hemoglobin level and concurrent infection with tuberculosis were independent risk factors for mortality, while ART initiated shortly after admission for VL treatment was associated with a 64-66% reduced risk of mortality and 75% reduced risk of relapse. SIGNIFICANCE:This is the ... |
format |
Article in Journal/Newspaper |
author |
Sakib Burza Raman Mahajan Prabhat K Sinha Johan van Griensven Krishna Pandey María Angeles Lima Marta Gonzalez Sanz Temmy Sunyoto Sunil Kumar Gaurab Mitra Ranjeet Kumar Neena Verma Pradeep Das |
author_facet |
Sakib Burza Raman Mahajan Prabhat K Sinha Johan van Griensven Krishna Pandey María Angeles Lima Marta Gonzalez Sanz Temmy Sunyoto Sunil Kumar Gaurab Mitra Ranjeet Kumar Neena Verma Pradeep Das |
author_sort |
Sakib Burza |
title |
Visceral leishmaniasis and HIV co-infection in Bihar, India: long-term effectiveness and treatment outcomes with liposomal amphotericin B (AmBisome). |
title_short |
Visceral leishmaniasis and HIV co-infection in Bihar, India: long-term effectiveness and treatment outcomes with liposomal amphotericin B (AmBisome). |
title_full |
Visceral leishmaniasis and HIV co-infection in Bihar, India: long-term effectiveness and treatment outcomes with liposomal amphotericin B (AmBisome). |
title_fullStr |
Visceral leishmaniasis and HIV co-infection in Bihar, India: long-term effectiveness and treatment outcomes with liposomal amphotericin B (AmBisome). |
title_full_unstemmed |
Visceral leishmaniasis and HIV co-infection in Bihar, India: long-term effectiveness and treatment outcomes with liposomal amphotericin B (AmBisome). |
title_sort |
visceral leishmaniasis and hiv co-infection in bihar, india: long-term effectiveness and treatment outcomes with liposomal amphotericin b (ambisome). |
publisher |
Public Library of Science (PLoS) |
publishDate |
2014 |
url |
https://doi.org/10.1371/journal.pntd.0003053 https://doaj.org/article/d33fc12178744f9ea6e5fafe3dbd1bda |
long_lat |
ENVELOPE(-63.733,-63.733,-64.983,-64.983) |
geographic |
Arctic Indian Azar |
geographic_facet |
Arctic Indian Azar |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 8, Iss 8, p e3053 (2014) |
op_relation |
http://europepmc.org/articles/PMC4125300?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0003053 https://doaj.org/article/d33fc12178744f9ea6e5fafe3dbd1bda |
op_doi |
https://doi.org/10.1371/journal.pntd.0003053 |
container_title |
PLoS Neglected Tropical Diseases |
container_volume |
8 |
container_issue |
8 |
container_start_page |
e3053 |
_version_ |
1766347969625325568 |