World Health Organization (WHO) has updated its guidelines for the treatment of Human African Trypanosomiasis (HAT) in a bid to control the rapid spread of the deadly disease.
In a report released by WHO in June 2024, the new set of guidelines includes the reconfiguration of therapeutic choices in the administration of the new approved medicines.
This comes after the WHO interim guidelines for the treatment of gambiense HAT issued in 2019 added the new medicine fexinidazole as a therapeutic option.
Human African Trypanosomiasis (HAT) also known as sleeping sickness is a parasitic infection transmitted to humans through a bite from an infected tsetse fly in which the parasite multiplies in the lymph and blood causing unspecific signs and symptoms over time including sleeping disorders.
It mainly occurs in two forms: the gambiense HAT which is the slowly progressing form commonly found in western and central Africa and the rapid progressive form known as rhodesiense mainly found in eastern and southern Africa.
All age groups and sexes are at a risk of contracting both forms of the disease even though the prevalence is higher in adults than children.
According to WHO, there has been a significant decline in reported cases of HAT in the recent past from a high of 25000 cases in the year 2000 to less than 5000 as reported in 2022.
However, WHO is determined to eliminate the number of cases completely by the year 2030.
“WHO has included HAT among diseases targeted for elimination as stated in the WHO roadmap for neglected tropical diseases 2021-2030 where such diseases are targeted for elimination as a public health problem,” read part of the report.”
In a bid to halt the spread of the disease, the WHO report has also set the guidelines in the administration of five different medicines in the different phases of the disease.
Fexinidazole is set to be administered from diagnosis as an oral treatment with a prescribed dosage of 10 days (one dose per day) only to be taken after the patient has had a meal.
Additionally, administering the fexinidazole is more advantageous as compared to other treatment options that require injections and carry a risk of catheter or needle-related infections and generally necessitate hospitalization.
“Outpatient administration of fexinidazole is possible in patients with low expected risk of poor compliance with treatment therefore treatment should be directly observed in health facilities and can in particular situations be directly observed at home under strict supervision of trained health staff who must ensure daily compliance of drug intake with food for the total duration of treatment.”
However, in the first stage of gambiense HAT, another medicine known as pentamidine has been verified to be the first-choice treatment having proven to have a cure success rate of 93-98 percent for decades.
Pentamidine on the other hand is administered through intramuscular injection due to occurrence of severe hypertension after intravenous administration and is to be offered on a daily basis for a period of 7 days.
In addition, the Nifurtimox-eflornithine combination therapy (NECT) has been approved for the second stage gambiense HAT with a proven cure rate of 95-98 percent and is believed to avoid selection of drug resistance by the parasite.
Other medications approved in the WHO report include, Eflornithine monotherapy which is to be administered when NECT is not feasible for second stage gambiense HAT and Melarsoprol which has variable efficacy due to parasite resistance.
Finally, WHO says the guidelines set and forms of medication and treatment recommended are a step towards eradicating the epidemic pledging its commitment to end sleeping sickness infections as per the roadmap for neglected tropical diseases through more scientific research in order to curb the spread of the epidemic.
