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Early Prediction of Treatment Efficacy in Second-Stage Gambiense Human African Trypanosomiasis

Priotto, Gerardo
Bastard, Mathieu
Flevaud, Laurence
Etard, Jean-François
Published in PLOS Neglected Tropical Diseases. 2012, vol. 6, no. 6, p. e1662
Abstract Because Human African trypanosomiasis is fatal, it is crucial for the patient to determine if curative treatment has been effective. Unfortunately this is not possible without a 24-month laboratory follow-up, which is problematic and largely unaccomplished in the field reality. Studies that assessed early indicators have used small cohorts, yielding limited statistical power plus potential bias because of including patients with equivocal outcome. We tackled this problem by pooling a large dataset which allowed for selecting cases providing strictly unequivocal information, still numerous enough to produce sound statistical evidence. We studied predictors based on the CSF leucocytes count, a laboratory technique already available in the field, evaluating their predictive power at 6 and 12 months post-treatment. We found a predictor at 6 months (10 leucocytes/µL of CSF) that has sub-optimal accuracy but may be valuable in some particular situations, plus two-step algorithms at 6 and 12 months that offer sufficient confidence to shorten the patients' follow-up. Until better biomarkers are identified, these findings represent a significant advance for this neglected disease. Benefits are foreseen both for patients and for overburdened treatment facilities. In addition, research for new treatments can be accelerated by using early predictors.
PMID: 22701752
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PRIOTTO, Gerardo et al. Early Prediction of Treatment Efficacy in Second-Stage Gambiense Human African Trypanosomiasis. In: PLOS Neglected Tropical Diseases, 2012, vol. 6, n° 6, p. e1662. https://archive-ouverte.unige.ch/unige:31912

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Deposited on : 2013-12-09

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