| Summary: | The parasitic disease visceral leishmaniasis (VL) causes a significant burden of illness and death in India. The main drug used to treat VL, which is based on the chemical element antimony, stopped working well in about half of all patients in the late twentieth century. We hypothesised that arsenic exposure of the Indian population, through contaminated groundwater, was contributing to treatment failure with antimony based drugs. Arsenic and antimony are similar chemical elements and exposure of the parasite to arsenic within the liver of arsenic-exposed patients could allow the parasite to become resistant to treatment with antimony. Using a field-based questionnaire study we retrospectively evaluated whether arsenic exposure was linked to antimonial treatment failure in a cohort of 110 antimonial treated patients. No significant association was found, although this may be because the number of patients in the study was low as antimony use was officially discontinued in 2005 due to high rates of treatment failure. However, arsenic exposure was found to increase risk of mortality from VL particularly if death occurred more than 3 months after the symptoms of VL developed. More research into the relationship between arsenic exposure and mortality in VL is warranted.
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