PROPHYLAXIS OF VISCERAL LEISHMANIASIS IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED PATIENTS

OBJECTIVE: To assess the effectiveness of two regimens with allopurino l or pentavalent antimony as secondary prophylaxis for visceral leishm aniasis (VL) in human immunodeficiency virus (HIV)-infected patients. DESIGN: Retrospective, nonrandomized, open trial. SETTING: A 1,000-bed academic tertiary institutional hospital in Barcelona. PATIENTS: Fort y-six individuals over 14 years old with HIV infection, who recovered from an episode of VL between January 1988 and February 1995. INTERVEN TIONS: Twenty patients did not receive any prophylaxis, nine received 300 mg/8 h of allopurinol, and 17 received 850 mg once-a-month of pent avalent antimony. Patients were followed-up every 3 months, and the en dpoint of study was relapse of VL. RESULTS: Twenty-one patients had re current VL: 13 of 20 in the control group (65%), 5 of 9 in the allopur inol group (56%), and 3 of 17 in the antimonial group (18%). Kaplan-Me ier estimates of the probability of remaining relapse-free at 12 month s were 9% without prophylaxis (95% CI, 0-22%), 21% with allopurinol (9 5% CI, 0-51%), and 93% with antimonials (95% CI, 82-100%) (P < 0.001). Multivariate analysis showed that the only significant variables rela ted to relapsing course of VL were assignment to the antimonial group, and the fact that the patient had experienced a previous episode of V L. CONCLUSIONS: Pentavalent antimony given once a month is effective i n the prevention of VL relapses in HIV-infected individuals. It is a l ow-cost treatment that proved to be well tolerated. Therefore, pentava lent antimony should be considered a suitable agent for secondary prop hylaxis against VL.