Incidents of co-infection with Visceral Leishmaniasis (commonly known as Kala Azar, KA) and Human Immunodeficiency Virus (HIV) are increasingly being reported from Bihar, noted a team of researchers and warned that such patients are reaching late for medical treatment in Government hospitals.
They pointed out that symptoms of vector-borne disease KA caused by the sandfly are being often misdiagnosed in the private sector as seasonal fever, while care providers found it difficult to disentangle the clinical symptoms of KA and HIV, due to which patients reach late to district hospitals.
This was leading to high out of pocket expenditure, leaving the patients dependent on societal support to access care. Bihar has 80 per cent of the Kala Azar reported in India.
During the study researchers found that "patients highly valued income and health as indicators of a good quality life, and routinely went into debt accessing care in the private setup. This was due to perceptions of poor quality of care in the Government setup and a lack of knowledge regarding available Government services at the district level."
The researchers from Delhi-based Jawaharlal Nehru University, All India Institute of Medical Sciences, Patna and Medecins Sans Frontieres (MSF), Spain had interviewed 29 patients including 16 patients co-infected with Kala Azar and HIV and 13 patients co-infected with Kala Azar, HIV, and TB.
Among 29 patients, 24 were men while 5 were women.
"The economic impact of seeking care in the private sector combined with lost income during periods of illness contributed to feelings of anxiety and hopelessness among patients, and left them dependent on societal support to access care.
"The KA symptoms were often misdiagnosed in the private sector as seasonal fever, while care providers found it difficult to disentangle the clinical symptoms of KA and HIV, contributing to patients presenting late to district hospitals," they noted in the study Quality of life for patients co-infected with kala-azar and HIV: qualitative study from Bihar".
The study was presented here recently at an event MSF Scientific Day organised by the MSF. After treating more than 13,000 patients suffering from kala azar in Bihar since 2007, the MSF is now focusing on the diagnosis and treatment of HIV-kala azar co-infection.
The researchers were Pragya Kumar, Sanjay Pandey, Alok Ranjan, Chandra Mani Singh and Neeraj Agarwal from AIIMS, Patna, Amit Harshana, Mohit Nair, Shahwar Kazmi and Sakib Burza from Jawaharlal Nehru University and Fernanda Falero, Laura Moreto-Planas from Medecins Sans Frontieres, Barcelona, Spain.
This study is the first assessment of self-reported quality of life among patients with KA-HIV coinfection in the Asian context, and was particularly relevant to our work in order to understand how patients perceived treatment and why they presented late in seeking care, said the researchers.
According to experts, HIV and KA are mutually reinforcing infections, which means that HIV-infected people are vulnerable to KA, while KA advances an HIV infection.
MSF is focusing on kala azar-HIV co-infection because relapse and mortality rates are around 13 -14 times higher in comparison to cases of KA without HIV. "KA can also not be completely eliminated without addressing the KA-HIV co-infection. So while cases of primary KA are going down, the proportion of co-infections are on the rise, which presents a public health challenge and needs to be addressed comprehensively," explained Dr Deepak Kumar from MSF.