VISCERAL LEISHMANIASIS IN HIV-INFECTED PATIENTS - TREATMENT WITH HIGH-DOSE LIPOSOMAL AMPHOTERICIN-B (AMBISOME)

Visceral leishmaniasis (VL) in patients coinfected with human immunode ficiency virus (HIV) is often atypical, and characteristically relapse s after treatment. We treated 10 HIV infected patients (9 men) with pa rasitologically confirmed VL with liposomal amphotericin B ('AmBisome' ; L-AMB) at a dose of 4 mg/kg/day on days 1, 2, 3, 4, 5, 10, 17, 24, 3 1, and 38. Patients were hospitalized for the first 5 days, and were m onitored during, and 1 week and 1, 3 and 6 months after, L-AMB therapy . There were no serious adverse events, and L-AMB was well tolerated. 9/10 patients completed therapy, one patient defaulted at day 24. Clin ical improvement was seen in all nine patients and the bone marrow asp irate was cleared of visible/culturable parasites in 8/9 patients. Dur ing follow-up, one patient defaulted. The seven remaining patients rel apsed at 2, 3, 3, 5, 5, 6 and 7 months. Re-tratment with a variety of antileishmanial drugs was unsatisfactory. The time from first diagnosi s of VL to death in six patients was 5-40 months (mean 18.8 months). O nly one patient remained alive 26 months after treatment. L-AMB is saf e and provides a good initial clinical response. Intermittent dosing e nables a short period of hospitalization. However, relapse is probably inevitable.