Title
Combination treatment for visceral leishmaniasis patients coinfected with human immunodeficiency virus in IndiaCombination treatment for visceral leishmaniasis patients coinfected with human immunodeficiency virus in India
Author
Faculty/Department
Institute of Development Policy and Management
Faculty of Medicine and Health Sciences
Research group
Epidemiology and social medicine (ESOC)
Institute of Development Policy and Management - other
Publication type
article
Publication
Chicago, Ill.,
Subject
Biology
Human medicine
Source (journal)
Clinical infectious diseases. - Chicago, Ill.
Volume/pages
61(2015):8, p. 1255-1262
ISSN
1058-4838
ISI
000362953800007
Carrier
E
Target language
English (eng)
Full text (Publishers DOI)
Affiliation
University of Antwerp
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 Medecins Sans Frontieres 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.
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Full text (open access)
https://repository.uantwerpen.be/docman/irua/a68999/129415.pdf
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