# name
Arsenic exposure and outcomes of antimonial treatment in
                visceral leishmaniasis patients in Bihar, India: a retrospective
                cohort study

# metadata.dc.description.abstract[].value
BACKGROUND: In the late twentieth century, emergence of high
                rates of treatment failure with antimonial compounds (SSG) for
                visceral leishmaniasis (VL) caused a public health crisis in
                Bihar, India. We hypothesize that exposure to arsenic through
                drinking contaminated groundwater may be associated with SSG
                treatment failure due to the development of antimony-resistant
                parasites. METHODS: A retrospective cohort design was employed,
                as antimony treatment is no longer in routine use. The study was
                performed on patients treated with SSG between 2006 and 2010.
                Outcomes of treatment were assessed through a field
                questionnaire and treatment failure used as a proxy for parasite
                resistance. Arsenic exposure was quantified through analysis of
                5 water samples from within and surrounding the patient's home.
                A logistic regression model was used to evaluate the association
                between arsenic exposure and treatment failure. In a secondary
                analysis survival curves and Cox regression models were applied
                to assess the risk of mortality in VL patients exposed to
                arsenic. RESULTS: One hundred and ten VL patients treated with
                SSG were analysed. The failure rate with SSG was 59%. Patients
                with high mean local arsenic level had a non-statistically
                significant higher risk of treatment failure (OR = 1.78, 95% CI:
                0.7-4.6, p = 0.23) than patients using wells with arsenic
                concentration <10 mug/L. Twenty one patients died in our
                cohort, 16 directly as a result of VL. Arsenic levels >/= 10
                mug/L increased the risk of all-cause (HR 3.27; 95% CI: 1.4-8.1)
                and VL related (HR 2.65; 95% CI: 0.96-7.65) deaths. This was
                time dependent: 3 months post VL symptom development, elevated
                risks of all-cause mortality (HR 8.56; 95% CI: 2.5-29.1) and of
                VL related mortality (HR 9.27; 95% CI: 1.8-49.0) were detected.
                DISCUSSION/CONCLUSION: This study indicates a trend towards
                increased treatment failure in arsenic exposed patients. The
                limitations of the retrospective study design may have masked a
                strong association between arsenic exposure and selection for
                antimonial resistance in the field. The unanticipated strong
                correlation between arsenic exposure and VL mortality warrants
                further investigation.

# metadata.dc.relation.isformatof[].value
Reproducció del document publicat a:
                http://dx.doi.org/10.1371/journal.pntd.0003518

# metadata.dc.relation.ispartof[].value
PLoS Neglected Tropical Diseases, 2015, vol. 9, num. 3, p.
                e0003518

# metadata.dc.source[].value
Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
Arsenic exposure and outcomes of antimonial treatment in
                visceral leishmaniasis patients in Bihar, India: a retrospective
                cohort study