Visceral leishmaniasis in HIV infected patients: Treatment with high dose liposomal amphotericin B (AmBisome)

• Published in: The Journal of infection Vol. 32; no. 2; pp. 133 - 137
• Main Authors: Russo, R., Nigro, L.C., Minniti, S., Montineri, A., Gradoni, L., Caldeira, L., Davidson, R.N.
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.03.1996; Elsevier
• Subjects: Adult; AIDS-Related Opportunistic Infections - drug therapy; Amphotericin B - administration & dosage; Amphotericin B - adverse effects; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiparasitic agents; Biological and medical sciences; Drug Carriers; Female; human immunodeficiency virus; Humans; Leishmaniasis, Visceral - drug therapy; Liposomes; Male; Medical sciences; Pharmacology. Drug treatments; Human; Immunopathology; Protozoal disease; Treatment efficiency; Liposome; Kala azar; AIDS; Leishmaniasis; Parasitosis; Immune deficiency; Infection; Chemotherapy; Treatment; Polyenic compound; Viral disease; Parasiticid; Complication; High dose
• ISSN: 0163-4453; 1532-2742
• DOI: 10.1016/S0163-4453(96)91343-2

Visceral leishmaniasis (VL) in patients coinfected with human immunodeficiency virus (HIV) is often atypical, and characteristically relapses after treatment. We treated 10 HIV infected patients (9 men) with parasitologically confirmed VL with liposomal amphotericin B (‘AmBisome’: L-AMB) at a dose of 4 mg/kg/day on days 1, 2, 3, 4, 5, 10, 17, 24, 31, and 38. Patients were hospitalized for the first 5 days, and were monitored during, and 1 week and 1, 3 and 6 months after, L-AMB therapy. There were no serious adverse events, and L-AMB was well tolerated. 9/10 patients completed therapy, one patient defaulted at day 24. Clinical improvement was seen in all nine patients and the bone marrow aspirate was cleared of visible/culturable parasites in 8/9 patients. During follow-up, one patient defaulted. The seven remaining patients relapsed at 2, 3, 3, 5, 5, 6 and 7 months. Re-treatment with a variety of antileishmanial drugs was unsatisfactory. The time from first diagnosis of VL to death in six patients was 5–40 months (mean 18.8 months). Only one patient remained alive 26 months after treatment. L-AMB is safe and provides a good initial clinical response. Intermittent dosing enables a short period of hospitalization. However, relapse is probably inevitable.