Parasitology

Review Article

Update on field use of the available drugs for the chemotherapy of human African trypanosomiasis

P. P. SIMARROa1 c1, J. FRANCOa1, A. DIARRAa2, J. A. RUIZ POSTIGOa3 and J. JANNINa1

a1 World Health Organization, HTM/NTD 20, avenue Appia 1211, Geneva 27, Switzerland

a2 World Health Organization, IST/CA, P.O. Box 820, Libreville, Gabon

a3 World Health Organization, CTD/DCD, P.O. Box3: 7608, Nasr City, Cairo 11371, Egypt

SUMMARY

Despite the fact that eflornithine was considered as the safer drug to treat human African trypanosomiasis (HAT) and has been freely available since 2001, the difficulties in logistics and cost burden associated with this drug meant that the toxic melarsoprol remained the drug of choice. The World Health Organization responded to the situation by designing a medical kit containing all the materials needed to use eflornithine, and by implementing a training and drugs distribution programme which has allowed a transition to this much safer treatment. The introduction of the combination of nifurtimox and eflornithine (NECT) has accelerated the shift from melarsoprol to the best treatment available, due to reduced dosage and treatment time for eflornithine that has significantly lessened the cost and improved the burden of logistics encountered during treatment and distribution. The decrease in the use of more dangerous but cheaper melarsoprol has meant a rise in the per patient cost of treating HAT. Although NECT is cheaper than eflornithine monotherapy, an unexpected consequence has been a continuing rise in the per patient cost of treating HAT. The ethical decision of shifting to the best available treatment imposes a financial burden on HAT control programmes that might render long-term application unsustainable. These factors call for continuing research to provide new safer and more effective drugs that are simple to administer and cheaper when compared to current drugs.

(Received October 27 2011)

(Revised December 09 2011)

(Revised January 04 2012)

(Accepted January 05 2012)

(Online publication February 06 2012)

Correspondence:

c1 Corresponding author: HTM/NTD, 20, avenue Appia 1211 Geneva 27, Switzerland. Tel: +41 22 791 1345. Fax: +41 22 791 4777. E-mail: simarrop@who.int

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