[Liposomal amphotericin B in secondary prophylaxis of visceral leishmaniasis in HIV-infected patients: report of five clinical cases]

Pathol Biol (Paris). 2004 Mar;52(2):66-75. doi: 10.1016/j.patbio.2003.09.012.
[Article in French]

Abstract

Treatment of visceral leishmaniasis in HIV patients encounters inefficacy and relapse due to drug resistance, toxicity and immunodepression. Our goal was to evaluate treatment of these patients by liposomal amphotericin B (L-AmB). Since 1998, five clinical files were exploitable out of 13 patients. Protocols used bolus doses ranging between 2.9 and 4.1 mg/kg dispatched on 5-24 days, followed by maintenance dose ranging from 2.7 to 3.8 mg/kg every 15 days. Attack treatment involved high bolus dose (cumulated doses ranging from 60 to 86 mg/kg at day 30) and allowed favorable clinical and biological results with healing in four patients. Secondary prophylaxis with L-AmB has been efficacious and well tolerated in three patients. Although literature and study results cannot indicate a standard therapeutic care in these patients, an initial treatment by L-AmB at doses higher than marketing-approved doses with a secondary prophylaxis by L-AmB associated with an antiretroviral treatment seem to be major asset in order to obtain healing. Expanding this study to a multicenter trial should allow to better define the frequency and duration of the secondary prophylaxis and to evaluate the risk of therapeutic escape as well as the life-span increase.

Publication types

  • Review

MeSH terms

  • Adult
  • Amphotericin B / therapeutic use*
  • Animals
  • Antiprotozoal Agents / therapeutic use*
  • Drug Combinations
  • Drug Evaluation
  • Female
  • HIV Infections / complications*
  • Humans
  • Leishmania infantum
  • Leishmaniasis, Visceral / complications
  • Leishmaniasis, Visceral / drug therapy*
  • Male
  • Meglumine / therapeutic use
  • Meglumine Antimoniate
  • Organometallic Compounds / therapeutic use
  • Phosphatidylcholines / therapeutic use
  • Phosphatidylglycerols / therapeutic use
  • Recurrence
  • Retrospective Studies
  • Substance Abuse, Intravenous / complications
  • Treatment Outcome

Substances

  • Antiprotozoal Agents
  • Drug Combinations
  • Organometallic Compounds
  • Phosphatidylcholines
  • Phosphatidylglycerols
  • liposomal amphotericin B
  • Meglumine
  • Meglumine Antimoniate
  • Amphotericin B