Prophylaxis of visceral leishmaniasis in human immunodeficiency virus-infected patients

Ribera, Esteban; Ocaña, Imma; Otero, Jordi de; Cortés, Emilia Barrot; Gasser, I; Pahissa, Albert

doi:10.1016/s0002-9343(97)89503-4

Cited by 85 publications

(49 citation statements)

References 17 publications

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“…Based on this observation, several authors have recommended long-term secondary prophylaxis as done for other opportunistic infections in patients with Aids. Pentavalent antimony administered once a month seems to be efficient in preventing recurrence in these patients (Ribera et al 1996). Pentamidine has also been used for this purpose, with the advantage of simultaneously acting on Pneumocystis carinii (Lopez-Velez et al 1998).…”

Section: Opportunistic Disease Caused By Leishmania Spmentioning

confidence: 99%

Some Aspects of Protozoan Infections in Immunocompromised Patients: A Review

Ferreira

Borges

2002

Mem. Inst. Oswaldo Cruz

192

130

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Section: Opportunistic Disease Caused By Leishmania Spmentioning

confidence: 99%

Some Aspects of Protozoan Infections in Immunocompromised Patients: A Review

Ferreira

Borges

2002

Mem. Inst. Oswaldo Cruz

192

130

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“…24 Secondary prophylaxis has previously been tried in HIV-VL especially in Europe and Africa. The agents used for secondary prophylaxis were pentavalent antimony (24 patients), 25,26 liposomal AmB (14 patients), 26,27 AmB lipid complex (eight patients), 28 and pentamidine (75 patients, mostly from Ethiopia, uncontrolled). 26,29,30 No systematic study on secondary prophylaxis has been conducted in India, one of the largest contributors of the global burden of leishmaniasis.…”

Section: Discussionmentioning

confidence: 99%

Protective Efficacy of Secondary Prophylaxis Against Visceral Leishmaniasis in Human Immunodeficiency Virus Coinfected Patients Over the Past 10 Years in Eastern India

Goswami

Basu

et al. 2017

The American Society of Tropical Medicine and Hygiene

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Abstract. Coinfection with visceral leishmaniasis (VL) and human immunodeficiency virus (HIV) leads to frequent treatment failure, relapse, and death. In this retrospective analysis from eastern India (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015), our primary objective was to ascertain the protective efficacy of secondary prophylaxis with monthly amphotericin B (AmB) given in patients with HIV-VL coinfection toward reducing relapse and mortality rates. The secondary objective was to compare clinical features, laboratory findings, and treatment outcomes in HIV-VL patients in contrast to VL monoinfection. Overall, 53 cases of HIV-VL and 460 cases of VL monoinfection were identified after excluding incomplete records. Initial cure rate was 96.23% in HIV-VL (27 received liposomal AmB and 26 AmB deoxycholate). All patients with initial cure (N = 51) were given antiretroviral therapy. Secondary prophylaxis (N = 27) was provided with monthly 1 mg/kg AmB (15 liposomal, 12 deoxycholate). No relapse or death was noted within 6 months in the secondary prophylaxis group (relapse: none versus 18/24 [75%]; mortality: none versus 11/24 [45.8%]; P < 0.001 for both). Secondary prophylaxis remained the sole significant predictor against death in multivariate Cox regression model (hazard ratio = 0.09 [95% confidence interval = 0.03-0.31]; P < 0.001). HIV-VL patients had higher 6-month relapse rate, less relapsefree 12-month survival, and higher mortality (P < 0.001 each) than VL monoinfection. In conclusion, it appears from this study that secondary prophylaxis with monthly AmB might be effective in preventing relapse and mortality in HIV-VL.

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“…Una vez finalizado el tratamiento en los pacientes coinfectados con VIH, se sugiere mantener una profilaxis secundaria hasta que la terapia antirretroviral logre que los linfocitos CD4 aumenten sobre 350, la replicación viral esté controlada y, además, el paciente se haya mantenido al menos un año sin recaída 4,15,16 . En el caso de utilizarse anfotericina B, la dosis recomendada es de 50 mg iv al mes, mientras que para la forma liposomal es de 3-5 mg/ kg iv cada 2 a 4 sem.…”

Section: Discussionunclassified

Leishmaniosis visceral en un paciente con infección por VIH

Olea¹

2013

Rev. chil. infectol.

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Leishmaniasis is a parasitic disease caused by the protozoa of the genus Leishmania transmitted by sandfly bites. It causes subclinical infection and diverse clinical manifestations with cutaneous, mucosal or visceral involvement. The last one, called visceral leishmaniasis, is usually fatal without treatment and in VIH patients with deep immunosuppression, has been recognized as an opportunistic infection with a high degree of difficulty in diagnosis and treatment. We present the case of a patient with HIV infection and visceral leishmaniasis. The clinical presentation was a prolonged febril syndrome with hepatosplenomegaly, lymphadenopathy and pancytopenia. The diferential diagnosis was made with lymphoma and other opportunistic infections, as mycobacteriosis. The bone marrow aspirate reveled parasite amastigotes. The patient received treatment with amphotericin B deoxycholate for 14 days and 2 months after he relapsed. Then he was treated with the same drug for 21 days and after that he has been in prophylaxis for 29 months with good outcome, without any other relapse.Key words: Visceral leishmaniasis, VIH, opportunistic infection. Palabras clave: Leishmaniasis visceral, VIH, infección oportunista. IntroducciónL a leishmaniosis es una infección crónica causada por un protozoo intracelular del género Leishmania y transmitida por mosquitos hematófagos. Afecta en forma endémica a países de Asia especialmente el subcontinente indio, África, Latinoamérica y la cuenca mediterránea 1 . Existen variadas formas de presentación en el hombre siendo tres las principales: leishmaniosis cutánea, mucosa y visceral 2,3 . Esta última es la más grave y letal y puede afectar tanto a pacientes inmunocompetentes como inmunocomprometidos. Se considera que por cada infección clínica existen 30 a 100 casos subclínicos 1 . En los pacientes con infección por VIH con inmunocompromiso grave, la leishmaniosis visceral (LV) se presenta como una infección oportunista y en España, por ejemplo, llegó a ser la cuarta enfermedad más frecuente con que debutaba el SIDA antes del inicio de la terapia antirretroviral (TARV) de alta eficacia 4 . Las especies más frecuentemente involucradas en LV son: Leishmania donovani en Asia y África, Leishmania chagasi en Latinoamérica y Leishmania infantum en países del Mediterráneo 1 . En Latinoamérica sólo Uruguay y Chile están libres de la infección por este microorganismo por carecer del vector que la transmite. Sin embargo, debido a la facilidad con que las personas se trasladan actualmente entre países y continentes, solemos enfrentarnos a pacientes con infecciones que nos son ajenas y que resultan de difícil diagnóstico, como la leishmaniosis. Se presenta el caso clínico de un paciente con LV e infección por VIH atendido en el Hospital de Enfermedades Infecciosas Dr. Lucio Córdova en Santiago de Chile. Caso clínicoVarón de 50 años, heterosexual, con antecedente de consumo de alcohol y drogas no intravenosas. Había vivido en España por 25 años hasta dos años antes. No refería otras patologías personales ...

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Prophylaxis of visceral leishmaniasis in human immunodeficiency virus-infected patients

Cited by 85 publications

References 17 publications

Some Aspects of Protozoan Infections in Immunocompromised Patients: A Review

Some Aspects of Protozoan Infections in Immunocompromised Patients: A Review

Protective Efficacy of Secondary Prophylaxis Against Visceral Leishmaniasis in Human Immunodeficiency Virus Coinfected Patients Over the Past 10 Years in Eastern India

Leishmaniosis visceral en un paciente con infección por VIH

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