Episode: "A Long Way From Home"

Peru

Project Update: Cutaneous Leishmaniasis in Satipo, Peru

In this episode, Dr. Milena Rosales and Biologist Eugenia Alvarez are treating people who have contracted a disease known as cutaneous leishmaniasis in the rural region of Satipo, Peru. The drug they are using, sodium stibogluconate, or SSG, was created more than 70 years ago. It is administered through a drip and is painful and toxic, with occasionally dangerous side effects. Because there is no research and development being done into new drugs for leishmaniasis, it is all MSF has.

MSF opened the project in Satipo in February, 2001, in response to indications that cutaneous leishmaniasis was endemic to the isolated region, which is populated primarily by impoverished, ethnically marginalized groups with very little access to health care. For the first year, MSF concentrated on identifying people with the disease and assessing the need for an intervention.

After MSF identified two-and-a-half times as many cases as expected, the team’s objective became the creation of a sustainable local response to cutaneous leishmaniasis in Satipo; MSF aid workers began training local health workers to treat the disease while lobbying the Peruvian government to take over the burden of providing funding for treatment. By March, 2003, MSF had treated hundreds of people with cutaneous leishmaniasis in the region and had trained four district doctors and the staff of San Martin de Pagoa hospital in recognizing and treating the disease.

More importantly, the Peruvian Ministry of Health now provides a generic form of SSG which is 20 times cheaper than the branded alternative. Its mission accomplished, MSF closed the Satipo project. But the story of Satipo is one battle in a much larger war – in many countries across the globe, a deadlier form of leishmaniasis takes a terrible toll, and lack of a better treatment than SSG has led to drug-resistant strains of the disease.

A Lethal Cousin: Lack of Research and Development for Visceral Leishmaniasis Treatment

Leishmaniasis is spread by the bite of a sand fly. Although never fatal on its own, cutaneous leishmaniasis can be disfiguring if left untreated, and in some rare cases people have been killed by bacterial infections that result from the disease.

Cutaneous leishmaniasis has a lethal cousin, however, which affects the internal organs instead of the skin. This version of the disease, visceral leishmaniasis, or kala azar (translation, black fever), is endemic in 88 countries, but most cases of the disease occur in the Indian subcontinent (India, Bangladesh and Nepal), Sudan, and Brazil. Although most Westerners have never heard of Kala Azar, one person dies from the disease every ten minutes.

Moreover, in large parts of India, the drug has become ineffective because of parasite resistance. Miltefosine, an anti-cancer drug discovered in the mid-1990s, is the first oral drug to treat the disease, but treatment takes 4 weeks and is not indicated for women in childbearing age. It has only been registered in India. The real miracle drug is Ambisome® - it is simple to use (max. 10 days), revives patients within hours of getting the first shot, and has virtually no side effects. The drawback is that there is only one producer and it is astronomically expensive – the best current price offer is US$1,500-2,400 per treatment, well beyond the reach of most patients.

There is very little investment in development of new drugs for kala-azar, since there is little possibility of financial return. Veterinary research may provide some hope, since the disease also affects dogs in wealthy countries. Safer, simpler, and cheaper drugs and diagnostic tools are urgently needed, particularly for patients in Africa.

To read more about the crisis in research and development of treatment for visceral leishmaniasis, click here.