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JAC Advance Access originally published online on December 19, 2007
Journal of Antimicrobial Chemotherapy 2008 61(2):467; doi:10.1093/jac/dkm490
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Letters to the Editor

Efficacy of liposomal amphotericin B for secondary prophylaxis of visceral leishmaniasis in HIV-infected patients—authors’ response

I. Molina1,*, V. Falcó1, M. Crespo1, C. Riera2, E. Ribera1, A. Curran1, J. Carrio2, M. Diaz1, S. Villar del Saz1, R. Fisa2, P. López-Chejade2, I. Ocaña1 and A. Pahissa1

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

* Corresponding author. E-mail: imolina{at}vhebron.net

Keywords: leishmania , AMB , chemoprophylaxis

Sir,

We are in agreement with most of the comments of our colleague, Dr Collazos.1 The main limitation of our study,2 as we recognize in the discussion of the paper, is the small number of cases due to the fact that the incidence of symptomatic visceral leishmaniasis is low since the implementation of highly active antiretroviral therapy (HAART). To the best of our knowledge, this is the largest series in which the efficacy of liposomal amphotericin B chemoprophylaxis and the clinical outcome of the cohort are reported.

We are also aware that the results regarding the efficacy of liposomal amphotericin B for secondary prophylaxis are limited and should be balanced by the fact that 20% of patients at 12 months and 45% at 24 months still have relapses despite HAART and liposomal amphotericin B. As we expose in our paper, the host immunity plays an important role in preventing new episodes but we believe that secondary prophylaxis is necessary until a satisfactory and maintained immunity status is achieved. When we compare our results with the historical cohort, we do not pretend to analyse the superiority or inferiority of liposomal amphotericin B versus antimonials. We only want to point out that the proportions of patients free of relapse seem to be similar with both drugs. Our results support previously published work, demonstrating the benefit of secondary prophylaxis over no prophylaxis. In our opinion, liposomal amphotericin B is just an alternative to pentavalent antimonials in secondary prophylaxis. Of course a well-designed prospective randomized study would be the only way to clarify the real value of these drugs, however, the low incidence of visceral leishmaniasis in our setting appears to be a difficult problem to overcome. In the meanwhile, and recognizing its limitations, data obtained from observational studies may still have their role in this scenario.


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1 Collazos J. Comment on: Efficacy of liposomal mphotericin B for secondary prophylaxis of visceral leishmaniasis in HIV-infected patients. J Antimicrob Chemother. 61:466–7.

2 Molina I, Falcó V, Crespo M, et al. Efficacy of liposomal amphotericin B for secondary prophylaxis of visceral leishmaniasis in HIV-infected patients. J Antimicrob Chemother (2007) 60:837–42.[Abstract/Free Full Text]


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This Article
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