The phenomenon of treatment failures in Human African Trypanosomiasis

  title={The phenomenon of treatment failures in Human African Trypanosomiasis},
  author={Reto Brun and Reto Schumacher and C{\'e}cile Schmid and Christina Kunz and Christian Burri},
  journal={Tropical Medicine \& International Health},
Treatment of Human African Trypanosomiasis (HAT or sleeping sickness) relies on a few drugs which are old, toxic and expensive. The most important drug for the treatment of second stage infection is melarsoprol. During the last 50 years treatment failures with melarsoprol were not a major problem in Trypanosoma brucei gambiense patients. Commonly a relapse rate of 5–8% was reported, but in recent years it has increased dramatically in some important foci of T. b. gambiense sleeping sickness… 
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The possibility that parasites resistant to melarsoprol on the one hand, and eflornithine on the other, are present in the field indicates that genes capable of conferring drug resistance to both drugs are in circulation.
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A unique collection of T.b. gambiense from cured and relapsed patients, isolated in the same disease focus and within a limited period is established to investigate the mechanism behind abnormally high treatment failure rates in Mbuji-Mayi, D.R. Congo.
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The current drugs against African trypanosomes are reviewed, the mechanisms of drug resistance are discussed, and key issues for the control oftrypanosomiasis in face of the limited options for chemotherapy are addressed.
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Investment in clinical and pathophysiological research and a broad international commitment to fight trypanosomiasis in Africa are urgently needed.
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Human African trypanosomiasis has dramatically reemerged as a serious public health problem in the central African region and huge challenges occur in implementing previously successful strategies to regain control of the disease, in view of the weak or absent health systems in some of the most affected areas.
Human African Trypanosomiasis
The distribution of sleeping sickness nowadays parallels that of wars that have recently devastated parts of Africa, with the highest incidences occurring in the Democratic Republic of Congo, Angola, and Sudan, and the highest incidence is seen in DRC, where 20–25,000 cases are reported annually.
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The 10-day treatment schedule of melarsoprol for the treatment of late-stage gambiense sleeping sickness is found to be more cost- effective than the standard treatment and a highly cost-effective treatment option for implementation necessary in areas with scarce resources.


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