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Combination therapy effective for HIV patients with visceral leishmaniasis
Research published in Clinical Infectious Diseases suggests that treating visceral leishmaniasis in HIV patients with a combination therapy of AmBisome and Impavido may be more effective than monotherapy with AmBisome.
“[Visceral leishmaniasis (VL)] is endemic in the Indian state of Bihar, which accounts for 40% of the worldwide burden of VL. Although the prevalence of [HIV] in Bihar is considered low (0.2%-0.3%), it is one of the few states where prevalence is increasing,” researcher Raman Mahajan, MSc, MPH, epidemiologist at Médicins Sans Frontières, New Delhi, India, and colleagues wrote.
The researchers said symptomatic VL is an opportunistic infection that patients with HIV can acquire before being diagnosed with HIV. It may be a consequence of the reactivation of dormant Leishmania infection as a result of both diseases reducing patients’ immunity, or “due to a much higher rate of clinical manifestation following primary Leishmania infection after acquiring HIV.”
Raman Mahajan
VL often presents with atypical clinical features, and the investigators said evidence-based treatment recommendations are nonexistent for coinfected patients in Asia.
Mahajan and colleagues conducted a retrospective study of 102 VL and HIV-coinfected patients who were given a combination treatment of 30 mg/kg intravenous AmBisome (liposomal amphotericin B, Gilead Sciences) and 14 days of 100 mg oral Impavido (miltefosine, Knight Therapeutics) between July 2012 and September 2014 at a government hospital in Vaishali District, Bihar.
Ninety-four patients received ART, and four of the ART-naive patients died within 4 months of completing VL treatment, according to the researchers. Of those who received ART, 51% started therapy before initiating VL treatment; the remainder began ART after completing VL treatment.
When comparing HIV-VL coinfected patients receiving ART, those taking the combination amphotericin B and miltefosine experienced slightly higher mortality at 12 months (11.2% vs 8.7%) than those taking a single, lower dose of 20 mg/kg to 25 mg/kg amphotericin B during a previous study, but a significantly lower rate of relapse (6.4% vs 16.2%), the researchers wrote.
Excluding ART-naive patients, tuberculosis (adjusted HR = 5.3, 95% CI, 1.6-17.8) was the only clinical or sociodemographic factor associated with poor outcomes, according to the researchers.
“Patients frequently relapse, and with limited treatment options available, ensuring that coinfected patients are able to receive effective treatment means combination treatment may also reduce the likelihood of developing drug resistance,” researcher Sakib Burza, MBChB, MSc, MD and operational research at Médecins Sans Frontières, told Infectious Disease News. “With limited existing evidence, the use of combination treatment should be considered in patients coinfected with HIV and visceral leishmaniasis from the Indian subcontinent.” – by David Jwanier
Disclosure: The researchers report no relevant financial disclosures.