Chemotherapy for second stage Human African trypanosomiasis Human African trypanosomiasis (HAT), or sleeping sickness, is one of the truly neglected tropical diseases. Trypanosomes (parasites) are transmitted through the bite of infected tsetse flies, and the disease, found in rural parts of sub-Saharan Africa, has two phases with different symptoms. This review written by Vittoria Lutje, Jorge Seixas and Adrian Kennedy, focuses on treatment of second-stage HAT, which is characterized by neurological changes and is almost invariably fatal without treatment. At present there are only a few drugs available for second-stage HAT (melarsoprol, eflornithine, nifurtimox), all with considerable adverse events and variable efficacy. The review includes nine trials with 2577 participants. Each trial reported different comparisons so no meta-analysis was possible. A short (10-day) regimen of melarsoprol, a drug which gives many adverse reactions including a severe neurological syndrome and death, was found to be as effective as 26-day regimens. The nifurtimox and eflornithine combination therapy (NECT) was assessed in recent trials and found to give few relapses and to be generally well tolerated. This regimen also reduces the burden on health personnel and patients, and its use is likely to result in a gradual reduction in melarsoprol use. However, all current therapeutic options for HAT give adverse events and are not easy to administer, and it is essential that new anti-trypanosomal compounds are developed and tested in experimental and clinical studies. Future research should also focus on the reduction of the adverse effects of currently used drugs, and better diagnostic tests.
Lutje, V.; Seixas, J.; Kennedy, A. Chemotherapy for second-stage Human African trypanosomiasis. Cochrane Database of Systematic Reviews (2010) (8) CD006201. [DOI: 10.1002/14651858.CD006201.pub2]