Better clinical management of Visceral Leishmaniasis in HIV patients in Ethiopia: secondary prophylaxis and HAART optimization.

BACKGROUND: The clinical management of HIV/leishmaniasis co-infected patients is challenging, as both pathogens undermine host immunity in a synergistic way, leading to very poor clinical outcomes even under HAART therapy, with repeated relapses of VL. The use of secondary prophylaxis for prevention of VL relapse was promising in some studies in Europe but was not yet tested in an African setting. Though the antileishmania effect of HIV protease inhibitors was demonstrated in in vitro studies, and has therefore potential to improve clinical response, it is not yet evaluated in a well designed clinical trial. Moreover, the syndrome poses many challenges in diagnosis and follow-up. In Ethiopia the prevalence of HIV and VL co-infection is very high.
OBJECTIVES: This PhD project is aimed at improving the clinical management of HIV/VL co-infected patients in Ethiopia by addressing challenges in diagnosis, treatment and follow-up.
METHODS: A randomised controlled trial will be conducted to demonstrate the clinical effectiveness of PI drugs for sustained leishmania control among HIV/VL co-infected patients. The value of secondary prophylaxis to prevent VL relapse will be prospectively assessed. Additionally, we will evaluate the accuracy of markers for diagnosis and clinical monitoring. This includes studies on the resistance pattern of the leishmania parasite, the accuracy of rapid HIV tests in VL patients and the use of non invasive monitoring tools as predictors for relapse.

Trefwoorden:B780-tropische-geneeskunde