A Comparison of Miltefosine and Sodium Stibogluconate for Treatment of Visceral Leishmaniasis in an Ethiopian Population with High Prevalence of HIV Infection

Background. Antimonials are the mainstay of visceral leishmaniasis (VL) treatment in Africa. The increasing incidence of human immunodeficiency virus (HIV) coinfection requires alternative safe and effective drug regimens. Oral miltefosine has been proven to be safe and effective in the treatment of Indian VL but has not been studied in Africa or in persons with HIV and VL coinfection. Methods. We compared the efficacy of miltefosine and sodium stibogluconate (SSG) in the treatment of VL in persons in Ethiopia. A total of 580 men with parasitologically and/or serologically confirmed VL were randomized to receive either oral miltefosine (100 mg per day for 28 days) or intramuscular SSG (20 mg/kg per day for 30 days). Results. The initial cure rate was 88 % in both treatment groups. Mortality during treatment was 2 % in the miltefosine group, compared with 10 % in the SSG group. Initial treatment failure was 8 % in the miltefosine group, compared with 1 % in the SSG group. Among the 375 patients (65%) who agreed to HIV testing, HIV seroprevalence was 29%. Among patients not infected with HIV, initial cure, mortality, and initial treatment failure rates were not significantly different (94 % vs. 95%, 1 % vs. 3%, and 5 % vs. 1 % for the miltefosine and SSG groups, respectively). Initial treatment failure with miltefosine occurred in 18 % of HIV-coinfected patients, compared with treatment failure in 5 % of non–HIV-infected patients. At 6 months after treatment, 174 (60%) of the 290 miltefosine recipient