JAC Advance Access originally published online on August 7, 2007
Journal of Antimicrobial Chemotherapy 2007 60(4):837-842; doi:10.1093/jac/dkm294
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Efficacy of liposomal amphotericin B for secondary prophylaxis of visceral leishmaniasis in HIV-infected patients
1 Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain 2 Laboratori de Parasitologia, Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
Received 14 March 2007; returned 24 April 2007; revised 30 April 2007; accepted 11 July 2007
* Corresponding author. Tel: +34-93-2746090; Fax: +34-93-4282762; E-mail: imolina{at}vhebron.net
Background and objectives: Visceral leishmaniasis (VL) is characterized by frequent relapses in HIV-infected patients, even in those who receive secondary prophylaxis. The aim of our study was to evaluate the efficacy of liposomal amphotericin B (L-AMB) for secondary prophylaxis of VL in HIV-infected patients.
Methods: From January 2001 to December 2005, 17 HIV patients, with at least one previous episode of VL who received L-AMB as secondary prophylaxis for VL, were included in the study. Efficacy was measured as the proportion of patients remaining free (non-relapse) of VL at different time points. Relapses were analysed as time-to-relapse distribution and were evaluated by survival analysis using the Kaplan–Meier method.
Results: Twenty-one episodes of VL were diagnosed and nine relapsed. The median follow-up time was 14 (5–44) months. The probability of remaining free of relapse at 6 months was 89.7% (95% CI, 76.2–100); at 12 months, the probability was 79.1% (95% CI, 61–97.2) and at 24 and 36 months, the probability was 55.9% (95% CI, 30.5–81.3). In the non-relapsing group, patients had a significant increase in CD4 cell levels of 102 (10–174) and 126 (4–159) cells/mm3 at 12 and 24 months, respectively (P = 0.037), whereas in the relapsing group, no significant increase was observed. Prophylaxis with L-AMB was well tolerated and only three patients had a mild impairment of renal function without requiring any change in treatment.
Conclusions: L-AMB is well tolerated and useful for secondary prophylaxis of VL.
Keywords: opportunistic infections , AIDS , AMB
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  J. Collazos Comment on: Efficacy of liposomal amphotericin B for secondary prophylaxis of visceral leishmaniasis in HIV-infected patients J. Antimicrob. Chemother., February 1, 2008; 61(2): 466 - 467. [Full Text] [PDF]
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I. Molina, V. Falco, M. Crespo, C. Riera, E. Ribera, A. Curran, J. Carrio, M. Diaz, S. Villar del Saz, R. Fisa, et al. Efficacy of liposomal amphotericin B for secondary prophylaxis of visceral leishmaniasis in HIV-infected patients--authors' response J. Antimicrob. Chemother., February 1, 2008; 61(2): 467 - 467. [Full Text] [PDF]
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