Journal ArticleDOI
Treatment of visceral leishmaniasis in HIV-infected patients: a randomized trial comparing meglumine antimoniate with amphotericin B
Fernando Laguna,Rogelio López-Vélez,Federico Pulido,Salas A,Julián Torre-Cisneros,Torres E,Francisco J. Medrano,José Sanz,Picó G,Gómez-Rodrigo J,Juan Pasquau,Jorge Alvar +11 more
TLDR
Treatment of VL with meglumine antimoniate or amphotericin B was shown to have similar efficacy and toxicity rates in Spanish HIV-infected patients, and the differences in the toxicity patterns could be useful in choosing one of these agents as first-line treatment.Abstract:
BACKGROUND Visceral leishmaniasis is common in patients with HIV infection living in endemic areas, but the most effective and safe treatment remains unknown. OBJECTIVE To compare the efficacy and safety of meglumine antimoniate versus amphotericin B in HIV-infected patients with first episodes of visceral leishmaniasis (VL). DESIGN An open, multicentre, prospective and randomized trial. SETTING Twelve tertiary hospitals. PATIENTS Eighty-nine consecutive HIV-infected patients diagnosed with VL. Patients were randomly assigned to treatment with either meglumine antimoniate (20 mg pentavalent antimony per kilogram of body weight per day) or amphotericin B (0.7 mg/kg per day) both for 28 days. Treatment was considered successful if a bone marrow aspirate performed 1 month after the end of therapy did not detect parasites. Relapse was defined as the reappearance of parasites after an initial cure. RESULTS An initial cure was attained in 29 of 44 patients (65.9%) randomly assigned to treatment with meglumine antimoniate and 28 of 45 (62.2%) randomly assigned to treatment with amphotericin B. The incidence of moderate to severe adverse events was similar in both groups. The patients treated with meglumine antimoniate had higher incidences of cardiotoxicity (14 versus 0%, P = 0.02) and chemical pancreatitis (30 versus 0%, P < 0.01). However, in the amphotericin B group, nephrotoxicity was more frequent (36 versus 5%, P < 0.01). There was no difference in survival or relapse-free interval according to the allocated group of therapy. CONCLUSION Treatment of VL with meglumine antimoniate or amphotericin B was shown to have similar efficacy and toxicity rates in Spanish HIV-infected patients. The differences in the toxicity patterns could be useful in choosing one of these agents as first-line treatment.read more
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Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America.
TL;DR: The most recent version of the guidelines for the prevention and treatment of opportunistic infections (OI) in HIV-infected adults and adolescents was published in 2002 and 2004, respectively as mentioned in this paper.
Journal ArticleDOI
Visceral leishmaniasis: what are the needs for diagnosis, treatment and control?
François Chappuis,François Chappuis,Shyam Sundar,Asrat Hailu,H. W. Ghalib,Suman Rijal,Rosanna W. Peeling,Jorge Alvar,Marleen Boelaert +8 more
TL;DR: Millefosine, paromomycin and liposomal amphotericin B are gradually replacing pentavalent antimonials and conventional amphoteric in B as the preferred treatments in some regions, but in other areas these drugs are still being evaluated in both mono- and combination therapies.
Journal ArticleDOI
Drug Resistance in Leishmaniasis
TL;DR: It is essential that there be a strategy to prevent the emergence of resistance to new drugs; combination therapy, monitoring of therapy, and improved diagnostics could play an essential role in this strategy.
Journal ArticleDOI
The Relationship between Leishmaniasis and AIDS: the Second 10 Years
Jorge Alvar,Pilar Aparicio,Abraham Aseffa,Margriet den Boer,Carmen Cañavate,Jean-Pierre Dedet,Luigi Gradoni,Rachel ter Horst,Rogelio López-Vélez,Javier Moreno +9 more
TL;DR: Based on the previous experience of 20 years of coinfection in Europe, this review focuses on the management of Leishmania-HIV-coinfected patients in low-income countries where leishmaniasis is endemic.
Journal ArticleDOI
Visceral leishmaniasis : current status of control, diagnosis, and treatment, and a proposed research and development agenda
Philippe J Guerin,Philippe J Guerin,Piero Olliaro,Piero Olliaro,Shyam Sundar,Marleen Boelaert,Simon L. Croft,Philippe Desjeux,Monique Wasunna,Anthony Bryceson +9 more
TL;DR: The current situation and perspectives for diagnosis, treatment, and control of visceral leishmaniasis are reviewed, and some priorities for research and development are listed.
References
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Human leishmaniasis: clinical, diagnostic, and chemotherapeutic developments in the last 10 years.
TL;DR: A review of leishmaniasis that are of practical value to practitioners, including presentation, diagnosis, and chemotherapy, can be found in this paper, where the authors emphasize advances in chemotherapy over the last 10 years.
Journal ArticleDOI
Leishmania and human immunodeficiency virus coinfection: the first 10 years.
Jorge Alvar,Carmen Cañavate,Beatriz Gutiérrez-Solar,Maribel Jiménez,Fernando Laguna,Rogelio López-Vélez,Ricardo Molina,Javier Moreno +7 more
TL;DR: Over 850 Leishmania-human immunodeficiency virus (HIV) coinfection cases have been recorded, the majority in Europe, where 7 to 17% of HIV-positive individuals with fever have amastigotes, suggesting that Leishmanniasis-infected individuals without symptoms will express symptoms of leishmaniasis if they become immunosuppressed.
Journal ArticleDOI
Recommendations for treating leishmaniasis with sodium stibogluconate (Pentostam) and review of pertinent clinical studies.
TL;DR: The evidence to date suggests that a regimen of 20 mg/kg/day of pentavalent antimony, without an upper limit on the daily dose, is more efficacious and is not substantially more toxic than regimens with lower daily doses.
Journal ArticleDOI
In vitro and in vivo resistance of Leishmania infantum to meglumine antimoniate: a study of 37 strains collected from patients with visceral leishmaniasis.
F. Faraut-Gambarelli,Renaud Piarroux,M. Deniau,Bernard Giusiano,Pierre Marty,Grégory Michel,B Faugère,H. Dumon +7 more
TL;DR: In vitro sensitivity of strains decreased progressively in relapsing patients treated with meglumine, and the physician may be encouraged to alternate me glumine with other treatments such as amphotericin B or pentamidine, especially in the case of relapsesing patients.
Journal ArticleDOI
Liposomal amphotericin B (AmBisome) in Mediterranean visceral leishmaniasis: a multi-centre trial.
Robert N. Davidson,L. di Martino,L Gradoni,Raffaella Giacchino,R. Russo,Giovanni Battista Gaeta,R. Pempinello,S. Scott,Francesco Raimondi,Antonio Cascio,Tullio Prestileo,L. Caldeira,Robert J. Wilkinson,A. D. M. Bryceson +13 more
TL;DR: Thirty-one patients with visceral leishmaniasis (VL) caused by Leishmania infantum received liposomal amphotericin B (AmBisome) in a multi-centre study and were cured without significant adverse events and without relapse during 12-24 months of follow-up.