Search our Database of Scientific Publications and Authors

I’m looking for a
    [Visceral Leishmaniasis in HIV-Infected Patients: The Challenge of Relapse and Treatment Failure].
    Acta Med Port 2017 Jun 30;30(6):443-448. Epub 2017 Jun 30.
    Serviço de Infeciologia. Hospital de Egas Moniz. Centro Hospitalar Lisboa Ocidental. Lisboa. Portugal.
    Introduction: Visceral leishmaniasis is an endemic disseminated infection, considered to be the third most frequent opportunistic parasitic infection in Europe. It is especially prevalent in patients co-infected with human immunodeficiency virus, in whom it poses a great therapeutic challenge due to increased risk of relapse. The goal of this study is to characterize a population of co-infected patients, as well as the efficiency of the adopted treatment strategies.

    Material And Methods: Retrospective study with a sample composed of all patients with visceral leishmaniasis and human immunodeficiency virus admitted in an Infectious Diseases ward over a period of 10 years.

    Results: Of the 23 enrolled patients, two were female (8.7%). The mean TCD4+ cell count was 104.4 cells/uL (± 120.3cells/uL), only two patients had undetectable viral load (< 20 copies/mL) and 16 (69.6%) were not under antiretroviral therapy at the time of diagnosis. Treatment-wise, liposomal amphotericin B was used in 18 patients, meglumine antimoniate in four and miltefosine in one. Fourteen (60.9%) were adherent to secondary prophylaxis protocol. A relapse rate of 26.1% was observed (six patients).

    Discussion: Co-infection is responsible for higher treatment failure rates and more relapses. TCD4+ cell count is the main predictive factor of relapse, and strict adherence to chemoprophylaxis protocols unequivocally results in a reduction of relapse rate. Combined treatment strategies using liposomal amphotericin B and miltefosine yield fewer therapeutic failures than the classic approach.

    Conclusion: We therefore conclude that alternative, combined therapeutic protocols seem to be a viable solution for these patients.

    Similar Publications

    Visceral leishmaniasis in human immunodeficiency virus (HIV)-infected and non-HIV-infected patients. A comparative study.
    Medicine (Baltimore) 2001 Jan;80(1):54-73
    Clinical Microbiology-Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain.
    Visceral leishmaniasis is an endemic infection in Mediterranean countries, where it has become a frequent complication of acquired immunodeficiency syndrome (AIDS). The incidence of visceral leishmaniasis is increasing in Spain due to human immunodeficiency virus (HIV)-related cases, but some aspects of its epidemiology, clinical features, and management remain unknown. In addition, no comparative clinical studies about the disease in HIV-infected and non-HIV-infected patients have been reported. Read More
    Multiple relapses of visceral leishmaniasis in a patient with HIV in India: a treatment challenge.
    Int J Infect Dis 2014 Aug 10;25:204-6. Epub 2014 Jun 10.
    Department of Medicine and Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India.
    Visceral Leishmaniasis (VL) is an opportunistic infection amongst HIV-infected people in several endemic countries, and the clinical management of this co-infection poses several challenges. Here we describe a co-infected patient in India who failed to respond to miltefosine monotherapy and subsequently relapsed following two further (different) regimens of liposomal amphotericin B. He was then successfully treated with a combination of 30 mg/kg liposomal amphotericin B and 14 days of 100mg/day oral miltefosine. Read More
    Treatment of visceral leishmaniasis in HIV-infected patients: a randomized trial comparing meglumine antimoniate with amphotericin B. Spanish HIV-Leishmania Study Group.
    AIDS 1999 Jun;13(9):1063-9
    Servicio de Enfermedades Infecciosas, Centro Nacional de Investigación Clínica, Instituto de Salud Carlos III, Madrid, Spain.
    Background: Visceral leishmaniasis is common in patients with HIV infection living in endemic areas, but the most effective and safe treatment remains unknown.

    Objective: To compare the efficacy and safety of meglumine antimoniate versus amphotericin B in HIV-infected patients with first episodes of visceral leishmaniasis (VL).

    Design: An open, multicentre, prospective and randomized trial. Read More
    Liposomal amphotericin B for visceral leishmaniasis in human immunodeficiency virus-coinfected patients: 2-year treatment outcomes in Bihar, India.
    Clin Infect Dis 2011 Oct;53(7):e91-8
    Rajendra Memorial Research Institute of Medical Science, Patna, Bihar.
    Background: Reports on treatment outcomes of visceral leishmaniasis (VL)-human immunodeficiency virus (HIV) coinfection in India are lacking. To our knowledge, none have studied the efficacy of liposomal amphotericin B in VL-HIV coinfection. We report the 2-year treatment outcomes of VL-HIV-coinfected patients treated with liposomal amphotericin B followed by combination antiretroviral treatment (cART) in Bihar, India. Read More