Combination treatment for visceral leishmaniasis patients co-infected with human immunodeficiency virus in India

BACKGROUND:  There are considerable numbers of patients co-infected 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 co-infected patients up to 18 months following treatment with a combination regimen.

METHODS:  This retrospective analysis included all patients with confirmed HIV-VL co-infection receiving combination treatment for VL at an MSF treatment centre between July 2012 and September 2014. Patients were treated with 30 mg/kg body weight intravenous liposomal amphotericin B (AmBisome®) divided as six 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 (IQR: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, while 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 co-infected patients.