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The last two comprehensive reviews on treatment of human African trypanosomiasis (HAT) were published in 1970 and 1980 (Apted, 1970a, 1980). Since then, there have been at last some innovations in the treatment of sleeping sickness, although most of the currently used drugs have been available for more than 50 years, a very rare situation in medicine. The optimism of the late 1950s concerning eventual eradication of HAT has proved to be premature. A resurgence of trypanosomiasis has occurred in several countries, linked to civil unrest or wars which resulted in the cessation, for only a few years, of the activities of national control programmes in Zaire, Angola, Uganda, Sudan and Tchad. Thus, for the next few decades at least, there will be tens of thousands of patients needing treatment each year for HAT throughout the African continent.

It is beyond the scope of this chapter to review the epidemiology or clinical features of HAT, and several references are available for those interested in such matters (Apted, 1970b, c; Scott, 1970; WHO, 1986). There has been no recent progress regarding the description of clinical signs of HAT, and relevant chapters of textbooks written during the last few decades are still appropriate. We will try only to provide answers to the questions a clinician has to address before selecting the therapeutic regimen for a patient with HAT or deciding if the patient needs further therapy.