Thirty-five year old Tsadik is a visceral leishmaniasis (VL) patient who is also infected with HIV. He is gaunt, weak and tired, with sunken eyes. Each breath he takes is laboured. Tsadik lives in Abdurafi, a region of northwest Ethiopia that is characterized with high VL-HIV co-infection because VL is endemic.
Four years ago, Tsadik left his home in Tieraf about 70 km from Abdurafi. He left his wife and three children behind, promising them a better life once he began his job as a farm labourer. Shortly after he settled in the small agricultural village, he fell ill and was diagnosed with VL. He went through a 30-day treatment regimen with SSG and was soon able to return to work. One year later, Tsadik was tested and found to be co-infected with HIV. He started treatment at a hospital close to his house but after relapsing with VL five times, he moved to Abdurafi Health Centre to access better treatment but again relapsed twice. “This disease has destroyed my life,” Tsadik says, “my wife left me, I can’t see my children as much as I used to and I was fired from my job because I was too weak to work. All that I had was used to pay medical bills.”
VL and HIV co-infection has become a major problem. Patients do not respond well to existing treatments, which are also difficult to tolerate due to many side effects. Patients frequently relapse and eventually the outcome can be fatal. There have been major strides in the treatment of both VL and HIV independently. However, treatments for patients co-infected with both diseases have remained elusive despite research efforts.
“Usually VL patients in this country are treated either with sodium stibogluconate (SSG) alone or SSG and paromomycin (SSG&PM), according to the national guidelines” explains Samuel Kassahun, a Health Officer at Abdurafi Hospital. “However, this has not been effective for HIV/VL patients and there is a need to find a better treatment. There are also concerns of toxicity in using SSG in the HIV co-infected population.”
The development of better treatment for HIV/VL is in progress, with promising results from a Phase III trial testing a combination therapy in Ethiopia.
“From such studies, my hope is that patients would finally get better treatments and have a normal life with no relapses,” says Tadelu Ajemu, a nurse at the Abdurafi Health Centre.
“My dream is to be cured so that I don’t have to come to hospital all the time. Then I can work and make sure my children remain in school. A new treatment will give me a better chance to do this,” concludes Tsadik with a smile on his face.