Liposomal amphotericin B for visceral leishmaniasis in human immunodeficiency virus-coinfected patients: 2-year treatment outcomes in Bihar, India

PK Sinha, J van Griensven, K Pandey, N Kumar, N Verma, R Mahajan, P Kumar, R Kumar, P Das, G Mitra, L Flevaud, C Ferreyra, D Remartinez, M Pece, PP Palma

    Research output: Contribution to journalA1: Web of Science-article

    Abstract

    BACKGROUND: Reports on treatment outcomes of visceral leishmaniasis (VL)-human immunodeficiency virus (HIV) coinfection in India are lacking. To our knowledge, none have studied the efficacy of liposomal amphotericin B in VL-HIV coinfection. We report the 2-year treatment outcomes of VL-HIV-coinfected patients treated with liposomal amphotericin B followed by combination antiretroviral treatment (cART) in Bihar, India. METHODS: The study included all patients with newly diagnosed VL-HIV coinfection and initiating treatment with liposomal amphotericin B (20-25 mg/kg in 4-15 days) between July 2007 and September 2010. Kaplan-Meier estimates of the cumulative incidence of death/treatment failure were calculated. RESULTS: Fifty-five patients were included (83.6% male; median age, 35 years; 62% migrant laborers; median follow-up, 1 year). The median CD4 cell count at VL diagnosis was 66 cells/muL (interquartile range, 38-112). Twenty-seven patients (49.1%) presented with VL relapse of VL. The overall tolerance of liposomal amphotericin B was excellent, with no interrupted treatment. Survival by 1 and 2 years after VL treatment was estimated at 85.5%. No patients had initial treatment failure. The probabilities of VL relapse were 0%, 8.1%, and 26.5% at 0.5, 1, and 2 years after VL treatment, respectively; relapse rates were similar for primary VL and VL relapse. CD4 counts <200 cells/muL at 6 months after cART initiation were predictive of subsequent relapse. The mean CD4 cell counts at 6 and 24 months after cART initiation were 187 and 261 cells/muL, respectively. The rate for retention in HIV care was 83.6%. CONCLUSIONS: Good long-term survival and retention rates were obtained for VL-HIV-coinfected patients treated with liposomal amphotericin B and cART. Although the initial VL treatment response was excellent, VL relapse within 2 years remained frequent.
    Original languageEnglish
    JournalClinical Infectious Diseases
    Volume53
    Issue number7
    Pages (from-to)e91-e98
    Number of pages8
    ISSN1058-4838
    DOIs
    Publication statusPublished - 2011

    Keywords

    • B780-tropical-medicine
    • Protozoal diseases
    • Visceral
    • Leishmaniasis
    • Kala azar
    • Leishmania donovani
    • Vectors
    • Sandflies
    • Phlebotomus argentipes
    • Co-infections
    • Viral diseases
    • HIV
    • AIDS
    • Treatment outcome
    • Liposomal amphotericin B
    • Efficacy
    • Evaluation
    • Relapses
    • CD4-positive-T-lymphocytes
    • Retention
    • Survival
    • India
    • Asia-South

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