Arsenic Exposure and Outcomes of Antimonial Treatment in Visceral Leishmaniasis Patients in Bihar, India: A Retrospective Cohort Study

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...

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Main Authors:	Perry, Meghan R., Prajapati, Vijay K., Menten, Joris, Raab, Andrea, Feldmann, Joerg, Chakraborti, Dipankar, Sundar, Shyam, Fairlamb, Alan H., Boelaert, Marleen, Picado, Albert
Format:	Online
Language:	English
Published:	Public Library of Science 2015
Online Access:	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4346263/

id	pubmed-4346263
recordtype	oai_dc
spelling	pubmed-43462632015-03-17 Arsenic Exposure and Outcomes of Antimonial Treatment in Visceral Leishmaniasis Patients in Bihar, India: A Retrospective Cohort Study Perry, Meghan R. Prajapati, Vijay K. Menten, Joris Raab, Andrea Feldmann, Joerg Chakraborti, Dipankar Sundar, Shyam Fairlamb, Alan H. Boelaert, Marleen Picado, Albert Research Article 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. Public Library of Science 2015-03-02 /pmc/articles/PMC4346263/ /pubmed/25730310 http://dx.doi.org/10.1371/journal.pntd.0003518 Text en © 2015 Perry et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
repository_type	Open Access Journal
institution_category	Foreign Institution
institution	US National Center for Biotechnology Information
building	NCBI PubMed
collection	Online Access
language	English
format	Online
author	Perry, Meghan R. Prajapati, Vijay K. Menten, Joris Raab, Andrea Feldmann, Joerg Chakraborti, Dipankar Sundar, Shyam Fairlamb, Alan H. Boelaert, Marleen Picado, Albert
spellingShingle	Perry, Meghan R. Prajapati, Vijay K. Menten, Joris Raab, Andrea Feldmann, Joerg Chakraborti, Dipankar Sundar, Shyam Fairlamb, Alan H. Boelaert, Marleen Picado, Albert Arsenic Exposure and Outcomes of Antimonial Treatment in Visceral Leishmaniasis Patients in Bihar, India: A Retrospective Cohort Study
author_facet	Perry, Meghan R. Prajapati, Vijay K. Menten, Joris Raab, Andrea Feldmann, Joerg Chakraborti, Dipankar Sundar, Shyam Fairlamb, Alan H. Boelaert, Marleen Picado, Albert
author_sort	Perry, Meghan R.
title	Arsenic Exposure and Outcomes of Antimonial Treatment in Visceral Leishmaniasis Patients in Bihar, India: A Retrospective Cohort Study
title_short	Arsenic Exposure and Outcomes of Antimonial Treatment in Visceral Leishmaniasis Patients in Bihar, India: A Retrospective Cohort Study
title_full	Arsenic Exposure and Outcomes of Antimonial Treatment in Visceral Leishmaniasis Patients in Bihar, India: A Retrospective Cohort Study
title_fullStr	Arsenic Exposure and Outcomes of Antimonial Treatment in Visceral Leishmaniasis Patients in Bihar, India: A Retrospective Cohort Study
title_full_unstemmed	Arsenic Exposure and Outcomes of Antimonial Treatment in Visceral Leishmaniasis Patients in Bihar, India: A Retrospective Cohort Study
title_sort	arsenic exposure and outcomes of antimonial treatment in visceral leishmaniasis patients in bihar, india: a retrospective cohort study
description	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.
publisher	Public Library of Science
publishDate	2015
url	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4346263/
_version_	1613194223701458944

Arsenic Exposure and Outcomes of Antimonial Treatment in Visceral Leishmaniasis Patients in Bihar, India: A Retrospective Cohort Study

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