The Medicines Sans Frontiers (MSF) has asked the Indian government to include liposomal amphotericin B in the Indian treatment protocol as a first line treatment option for visceral leishmaniasis, popularly known as 'kala azar'. MSF's projects in Bihar show treatment with liposomal amphotericin B is very effective, with a 98 per cent cure rate and a low death and defaulter rate.

Presenting results in this regard at the fourth Leishmaniasis World Congress in Lucknow, MSF tropical medical advisor Dr Nines Lima said, "While liposomal amphotericin B is not the only possible treatment, it has been shown to be one of the most effective and safe. We believe it should be included in the Indian treatment protocol as a first line treatment option".

The MSF said that there is a serious need to expand availability of effective treatments and diagnosis for kala azar in order to reduce the present burden of disease and resistance to treatments. Fatal, if left untreated, kala azar is transmitted by the bite of an infected sand fly. Largely unknown in the developed world, it is a parasitic disease that affects over 12 million people worldwide. The annual incidence is estimated to be 500,000 cases, with 50 per cent occurring in India. The disease is endemic in the eastern states of Bihar, Jharkhand, Uttar Pradesh and West Bengal. In these states, it is marginalized communities living in rural poverty who bear the greatest disease burden.

The most common treatment currently used is sodium stibogluconate (SSG). However, resistance to the drug is a growing problem - especially in India, where as many as 65 per cent of patients acquire drug resistant parasites. Kala azar remains neglected by research and development initiatives.

MSF said that the patients of kala azar in developing countries have been neglected for far too long. In the MSF's Bihar project, most patients come to the facilities when the disease is already at an advanced stage because people are still not familiar with the signs and symptoms or do not know where they can find adequate diagnosis and medication. Many communities with high prevalence, lack access to diagnostics and poverty often means that the quality of treatment is poor which in turn poses serious risks of outbreaks and increasing drug resistance.

The drug liposomal amphotericin B is expensive at Rs. 21,855 (350 €) per patient per treatment. There is an urgent need for reducing the cost of the drug, developing generic formulations and validating combination therapy so that the drug can be included as a first line treatment in the protocols of countries such as India, MSF said.

In Bihar at the Hajipur referral hospital, MSF is providing diagnosis and treatment for people suffering from kala azar. Since July 2007, MSF has screened over 6,500 patients for kala azar and the 2,500 patients found to be positive received treatment with liposomal amphotericin B.