Miltefosine for visceral leishmaniasis relapse treatment and secondary prophylaxis in HIV-infected patients

Marques, Nuno; Sá, Rosa; Coelho, Filomena; Oliveira, Joaquim; Cunha, JG Saraiva da; Meliço-Silvestre, A.

doi:10.1080/00365540701787800

Cited by 24 publications

(17 citation statements)

References 22 publications

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“…Such studies are mostly based on secondary prophylaxis with ABLC [79] and LAB [80]. Other drugs used for secondary prophylaxis but with less supporting evidence are pentavalent antimonials [81], pentamidine [82]–[84], miltefosine [85], azole drugs [86], [87], and allopurinol, alone or in combination (Table 3) [88]–[90].…”

Section: Therapeutic and Prophylactic Strategies For Visceral Leishmamentioning

confidence: 99%

Visceral Leishmaniasis and HIV Coinfection in the Mediterranean Region

Monge‐Maíllo

Norman²,

Cruz³

et al. 2014

PLoS Negl Trop Dis

109

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Visceral leishmaniasis is hypoendemic in Mediterranean countries, where it is caused by the flagellate protozoan Leishmania infantum. VL cases in this area account for 5%–6% of the global burden. Cases of Leishmania/HIV coinfection have been reported in the Mediterranean region, mainly in France, Italy, Portugal, and Spain. Since highly active antiretroviral therapy was introduced in 1997, a marked decrease in the number of coinfected cases in this region has been reported. The development of new diagnostic methods to accurately identify level of parasitemia and the risk of relapse is one of the main challenges in improving the treatment of coinfected patients. Clinical trials in the Mediterranean region are needed to determine the most adequate therapeutic options for Leishmania/HIV patients as well as the indications and regimes for secondary prophylaxis. This article reviews the epidemiological, diagnostic, clinical, and therapeutic aspects of Leishmania/HIV coinfection in the Mediterranean region.

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Section: Therapeutic and Prophylactic Strategies For Visceral Leishmamentioning

confidence: 99%

Visceral Leishmaniasis and HIV Coinfection in the Mediterranean Region

Monge‐Maíllo

Norman²,

Cruz³

et al. 2014

PLoS Negl Trop Dis

109

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“…Miltefosine also induces several immunologic and inflammatory effects on macrophages. In animal models, miltefosine does not require T-cell-dependent immune mechanisms in order to act, indicating that this agent can be used in T-cell-deficient patients [182]. Recently, it was found that miltefosine enhanced IFN- γ receptors and thus IFN- γ responsiveness in L. donovani -infected macrophages; in the same model, miltefosine induced an IL-12-dependent Th1 response and reversed the Th2 response to Th1 response [183].…”

Section: Resistance To Antimonialsmentioning

confidence: 99%

Use of Antimony in the Treatment of Leishmaniasis: Current Status and Future Directions

Haldar

Sen

Roy

2011

Molecular Biology International

302

217

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In the recent past the standard treatment of kala-azar involved the use of pentavalent antimonials Sb(V). Because of progressive rise in treatment failure to Sb(V) was limited its use in the treatment program in the Indian subcontinent. Until now the mechanism of action of Sb(V) is not very clear. Recent studies indicated that both parasite and hosts contribute to the antimony efflux mechanism. Interestingly, antimonials show strong immunostimulatory abilities as evident from the upregulation of transplantation antigens and enhanced T cell stimulating ability of normal antigen presenting cells when treated with Sb(V) in vitro. Recently, it has been shown that some of the peroxovanadium compounds have Sb(V)-resistance modifying ability in experimental infection with Sb(V) resistant Leishmania donovani isolates in murine model. Thus, vanadium compounds may be used in combination with Sb(V) in the treatment of Sb(V) resistance cases of kala-azar.

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“…Different regimens with several drugs have been used, including pentavalent antimonials (20 mg/kg/day given every 3 to 4 weeks), Amphotericin B (either L-AMB or amphotericin lipid complex) (3 to 5 mg/kg/day given every 3 to 4 weeks), and pentamidine (4 mg/kg/day given every 3 to 4 weeks), but there are no well-established protocols [1]. In a small study, miltefosine was used for secondary prophylaxis of VL in HIV-infected subjects at a dose of 50 mg/day given 3 times a week [16]. However, prospective studies are needed to establish the optimal therapeutic approach to relapsing VL.…”

Section: Discussionmentioning

confidence: 99%

Atypical Presentation of PKDL due toLeishmania infantumin an HIV-Infected Patient with Relapsing Visceral Leishmaniasis

Celesia

Cacopardo

Massimino

et al. 2014

Case Reports in Infectious Diseases

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We describe the case of an Italian patient with HIV infection who developed an atypical rash resembling post-kala-azar dermal leishmaniasis (PKDL) when receiving liposomal Amphotericin B (L-AMB) for secondary prophylaxis of visceral leishmaniasis (VL). At the time of PKDL appearance, the patient was virologically suppressed but had failed to restore an adequate CD4+ T-cell count. Histology of skin lesions revealed the presence of a granulomatous infiltrate, with lymphocytes, plasma cells, and macrophages, most of which contained Leishmania amastigotes. Restriction fragment length polymorphism-polymerase chain reaction was positive for Leishmania infantum. Paradoxically, cutaneous lesions markedly improved when a new relapse of VL occurred. The patient received meglumine antimoniate, with a rapid clinical response and complete disappearance of cutaneous rash. Unfortunately, the patient had several relapses of VL over the following years, though the interval between them has become wider after restarting maintenance therapy with L-AMB 4 mg/kg/day once a month. Even if rare, PKDL due to Leishmania infantum may occur in Western countries and represents a diagnostic and therapeutic challenge for physicians. The therapeutic management of both PKDL and VL in HIV infection is challenging, because relapses are frequent and evidence is often limited to small case series and case reports.

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Miltefosine for visceral leishmaniasis relapse treatment and secondary prophylaxis in HIV-infected patients

Cited by 24 publications

References 22 publications

Visceral Leishmaniasis and HIV Coinfection in the Mediterranean Region

Visceral Leishmaniasis and HIV Coinfection in the Mediterranean Region

Use of Antimony in the Treatment of Leishmaniasis: Current Status and Future Directions

Atypical Presentation of PKDL due toLeishmania infantumin an HIV-Infected Patient with Relapsing Visceral Leishmaniasis

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