Journal Article > ResearchFull Text
Clin Infect Dis. 30 June 2015 (Issue 8)
Mahajan R, Das P, Isaakidis P, Sunyoto T, Sagili KD, et al.
Clin Infect Dis. 30 June 2015 (Issue 8)
There are considerable numbers of patients co-infected with Human Immunodeficiency Virus (HIV) and Visceral Leishmaniasis (VL) in the VL-endemic areas of Bihar, India. These patients are at higher risk of relapse and death, but there are still no evidence-based guidelines on how to treat them. In this study, we report on treatment outcomes of co-infected patients up to 18 months following treatment with a combination regimen.
Journal Article > ResearchFull Text
PLoS Negl Trop Dis. 7 August 2014; Volume 8 (Issue 8); e3053.; DOI:10.1371/journal.pntd.0003053
Burza S, Mahajan R, Singh A, van Griensven J, Pandey K, et al.
PLoS Negl Trop Dis. 7 August 2014; Volume 8 (Issue 8); e3053.; DOI:10.1371/journal.pntd.0003053
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.
Journal Article > ResearchFull Text
Clin Infect Dis. 10 May 2014; Volume 59 (Issue 4); 552-555.; DOI:10.1093/cid/ciu333
Burza S, Mahajan R, Sanz MG, Sunyoto T, Kumar R, et al.
Clin Infect Dis. 10 May 2014; Volume 59 (Issue 4); 552-555.; DOI:10.1093/cid/ciu333
Although human immunodeficiency virus (HIV) and visceral leishmaniasis coinfection is recognized as a major public health challenge in Africa, data regarding the prevalence in India are very limited. Consecutive HIV screening of 2077 patients aged ≥14 years with confirmed visceral leishmaniasis in Bihar, eastern India, found that 5.6% were HIV positive, including 2.4% with newly diagnosed HIV infection.
Journal Article > ResearchFull Text
PLoS Negl Trop Dis. 2 January 2014; Volume 8 (Issue 1); e2603.; DOI:10.1371/journal.pntd.0002603
Burza S, Sinha PK, Mahajan R, Lima MA, Mitra G, et al.
PLoS Negl Trop Dis. 2 January 2014; Volume 8 (Issue 1); e2603.; DOI:10.1371/journal.pntd.0002603
Visceral Leishmaniasis (VL; also known as Kala-azar) is an ultimately fatal disease endemic in Bihar. A 2007 observational cohort study in Bihar of 251 patients with VL treated with 20 mg/Kg intravenous liposomal amphotericin B (Ambisome) demonstrated a 98% cure rate at 6-months. Between July 2007 and August 2012, Médecins Sans Frontières (MSF) and the Rajendra Memorial Research Institute (RMRI) implemented a VL treatment project in Bihar, India-an area highly endemic for Leishmania donovani-using this regimen as first-line treatment.
Journal Article > ResearchFull Text
PLoS Negl Trop Dis. 2 January 2014; Volume 8 (Issue 1); e2536.; DOI:10.1371/journal.pntd.0002536
Burza S, Sinha PK, Mahajan R, Lima MA, Mitra G, et al.
PLoS Negl Trop Dis. 2 January 2014; Volume 8 (Issue 1); e2536.; DOI:10.1371/journal.pntd.0002536
A proportion of all immunocompetent patients treated for visceral leishmaniasis (VL) are known to relapse; however, the risk factors for relapse are not well understood. With the support of the Rajendra Memorial Research Institute (RMRI), Médecins Sans Frontières (MSF) implemented a program in Bihar, India, using intravenous liposomal amphotericin B (Ambisome) as a first-line treatment for VL. The aim of this study was to identify risk factors for VL relapse by examining the characteristics of immunocompetent patients who relapsed following this regimen.
Journal Article > LetterFull Text
Clin Infect Dis. 1 November 2013; Volume 57 (Issue 9); DOI:10.1093/cid/cit508
Burza S, Nabi E, Mahajan R, Mitra G, Lima MA
Clin Infect Dis. 1 November 2013; Volume 57 (Issue 9); DOI:10.1093/cid/cit508
Journal Article > ResearchFull Text
Clin Infect Dis. 1 October 2011; Volume 53 (Issue 7); DOI:10.1093/cid/cir521
Sinha PK, van Griensven J, Pandey K, Kumar N, Verma N, et al.
Clin Infect Dis. 1 October 2011; Volume 53 (Issue 7); DOI:10.1093/cid/cir521
Reports on treatment outcomes of visceral leishmaniasis (VL)-human immunodeficiency virus (HIV) coinfection in India are lacking. To our knowledge, none have studied the efficacy of liposomal amphotericin B in VL-HIV coinfection. We report the 2-year treatment outcomes of VL-HIV-coinfected patients treated with liposomal amphotericin B followed by combination antiretroviral treatment (cART) in Bihar, India.
Journal Article > ResearchFull Text
Am J Trop Med Hyg. 1 August 2010; Volume 83 (Issue 2); 357-364.; DOI:10.4269/ajtmh.2010.10-0156
Sinha PK, Roddy P, Palma PP, Kociejowski A, Lima MA, et al.
Am J Trop Med Hyg. 1 August 2010; Volume 83 (Issue 2); 357-364.; DOI:10.4269/ajtmh.2010.10-0156
We evaluated, through the prospective monitoring of 251 patients at Sadar Hospital in Bihar, India, the effectiveness and safety of 20 mg/kg body weight of liposomal amphotericin B for the treatment of visceral leishmaniasis. The treatment success rates for the intention-to-treat, per protocol, and intention-to-treat worse-case scenario analyses were 98.8%, 99.6%, and 81.3%, respectively. Nearly one-half of patients experienced mild adverse events, but only 1% developed serious but non–life-threatening lips swelling. The lost to follow-up rate was 17.5%. Our findings indicate that the 20 mg/kg body weight treatment dosage is effective and safe under routine program conditions. Given that the exorbitant cost of liposomal amphotericin B is a barrier to its widespread use, we recommend further study to monitor and evaluate a lowered dosage and a shorter treatment course.
Journal Article > ResearchFull Text
PLoS Negl Trop Dis. 2 January 2014; Volume 8 (Issue 1); e2611.; DOI:10.1371/journal.pntd.0002611
Burza S, Sinha PK, Mahajan R, Gonzalez Sanz M, Lima MA, et al.
PLoS Negl Trop Dis. 2 January 2014; Volume 8 (Issue 1); e2611.; DOI:10.1371/journal.pntd.0002611
The skin disorder Post Kala-Azar Dermal Leishmaniasis (PKDL) occurs in up to 10% of patients treated for visceral leishmaniasis (VL) in India. The pathogenesis of PKDL is not yet fully understood. Cases have been reported in India following therapy with most available treatments, but rarely in those treated with liposomal amphotericin B (Ambisome). Between July 2007 and August 2012 with the support of the Rajendra Memorial Research Institute (RMRI), Médecins Sans Frontières (MSF) supported a VL treatment programme in Bihar, India-an area highly endemic for Leishmania donovani-in which 8749 patients received 20 mg/kg intravenous Ambisome as first-line treatment. This study describes the characteristics of patients who returned to the MSF supported treatment programme with PKDL.