Combination treatment for visceral leishmaniasis coinfected with human immunodeficiency virus in India
Combination therapy appeared to be well tolerated, safe, and effective in this Bihar study
Abstract
Background
There are considerable numbers of patients coinfected with human immunodeficiency virus (HIV) and visceral leishmaniasis (VL) in the VL-endemic areas of Bihar, India. These patients are at higher risk of relapse and death, but there are still no evidence-based guidelines on how to treat them. In this study, we report on treatment outcomes of coinfected patients up to 18 months following treatment with a combination regimen.
Methods
This retrospective analysis included all patients with confirmed HIV-VL coinfection receiving combination treatment for VL at a Médecins Sans Frontières treatment center between July 2012 and September 2014. Patients were treated with 30 mg/kg body weight intravenous liposomal amphotericin B (AmBisome) divided as 6 equal dose infusions combined with 14 days of 100 mg/day oral miltefosine (Impavido). All patients were encouraged to start or continue on antiretroviral therapy (ART).
Results
102 patients (76% males, 57% with known HIV infection, 54% with a prior episode of VL) were followed-up for a median of 11 months (interquartile range: 4–18). Cumulative incidence of all-cause mortality and VL relapse at 6, 12, and 18 months was 11.7%, 14.5%, 16.6% and 2.5%, 6.0%,13.9%, respectively. Cumulative incidence of poor outcome at 6, 12, and 18 months was 13.9%, 18.4%, and 27.2%, respectively. Not initiating ART and concurrent tuberculosis were independent risk factors for mortality, whereas no factors were associated with relapse.
Conclusions
In this Bihar-based study, combination therapy appeared to be well tolerated, safe, and effective and may be considered as an option for treatment of VL in HIV coinfected patients.
This research was supported by the UK Department for International Development’s Operational Research Capacity Building Programme led by the International Union Against TB and Lung Disease (The Union)
Citation
Raman Mahajan, Pradeep Das, Petros Isaakidis, Temmy Sunyoto, Karuna D Sagili, Marıa Angeles Lima, Gaurab Mitra, Deepak Kumar, Krishna Pandey, Jean-Pierre Van geertruyden, Marleen Boelaert, Sakib Burza. Combination treatment for visceral leishmaniasis coinfected with human immunodeficiency virus in India. Clinical Infectious Diseases. 2015 Oct 15;61(8):1255-62. doi: 10.1093/cid/civ530