An HIV/VL patient’s long road to better treatment

18 Jan 2019

Nigatu Abebe from Ethiopia sits on a bed in the Leishmaniasis Research and Treatment Centre (LRTC) at the University of Gondar in Ethiopia. He looks very frail and has been battling against visceral leishmaniasis (VL), also known as kala-azar, and HIV for 11 years.

Nigatu contracted visceral leishmaniasis – which causes fever, weight loss, swelling of the spleen and liver, and anemia – in 2007, while working as a farm labourer in Abdurafi in the North-Western part of Ethiopia. Initially ignoring his symptoms, he went to Abdurafi Hospital four months later and was diagnosed with both visceral leishmaniasis and HIV. Since then he has had four relapses, lost his job, and been rejected by friends and colleagues.

Visceral leishmaniasis, with up to 90,000 cases estimated in Asia, Africa and South America, is the second largest parasitic killer after malaria, with 20,000-30,000 deaths every year. Usually, once treated, patients become immune to the parasite, which is spread by the bite of sandflies. But HIV affects visceral leishmaniasis by altering its severity, worsening treatment outcomes and relapse rates, and increasing the risk of death.

Doctors first gave Nigatu sodium stibogluconate to treat his visceral leishmaniasis and ARVs for HIV. Two years later, he relapsed and went back to hospital. This time, he was given a treatment combination of miltefosine and AmBisome. His health improved and for over six years he was able to live a normal life, even travelling as far as Sudan to work. However, after his most recent relapse a few weeks ago, he has spent almost all his savings.

“I had to travel to Gondar all the way from Sudan to receive treatment. This was very costly for me.”
Nigatu Abebe

Despite the difficulties associated with treating HIV/VL co-infection, Nigatu remains hopeful about his future. At the LRTC – which was originally funded by DNDi to help the University of Gondar to conduct clinical trials – he is once again being treated by a combination of AmBisome with the oral drug miltefosine. Results from a DNDi Phase III study in Ethiopia in 2014 demonstrated the high efficacy of the combined therapy.