Maintenance itraconazole for visceral leishmaniasis in hiv infection

Lafeuillade, Alain; Chaffanjon, P.; Delbeke, Emmanuel; Quilichini, R

doi:10.1016/0002-9343(92)90281-f

Cited by 21 publications

(10 citation statements)

References 5 publications

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“…The experience is based on series of cases where itraconazole was given at a dose of 600 mg/day for up to 24 months of treatment, without any relapses. The advantage of these drugs is their good tolerability and low toxicity, although there is a risk of developing resistant fungal infections [ 122 , 123 ]. Itraconazole or fluconazole combined with allopurinol could be an option [ 124 , 10 ].…”

Section: Treatment Of Visceral Leishmaniasismentioning

confidence: 99%

Therapeutic Options for Visceral Leishmaniasis

Monge‐Maíllo

López‐Vélez

2013

Drugs

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Visceral leishmaniasis (VL), also known as Kala-Azar, is a disseminated protozoal infection caused principally by Leishmania donovani and Leishmania infantum (known as Leishmania chagasi in South America). The therapeutic options for VL are diverse and depend on different factors, such as the geographical area of the infection, development of resistance to habitual treatments, HIV co-infection, malnourishment and other concomitant infections. This article provides an exhaustive review of the literature regarding studies published on the treatment of VL, and gives therapeutic recommendations stratified according to their level of evidence, the species of Leishmania implicated and the geographical location of the infection.

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Section: Treatment Of Visceral Leishmaniasismentioning

confidence: 99%

Therapeutic Options for Visceral Leishmaniasis

Monge‐Maíllo

López‐Vélez

2013

Drugs

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“…The opportunistic infections that appear in HIV-positive individuals are recurrent, and highly potent primary or secondary prophylactic treatments are available. It has not been possible to show the effectiveness of any treatment in the prevention of recurrence of HIV-related VL, although pentamidine in dosages once every 3 to 4 weeks (105,181,224), liposomal amphotericin B in fortnightly doses (158,161,183), allopurinol (243), and itraconazol (150,239) have been used. Recently, it has been shown in a nonrandomized, retrospective, and open trial with 37 patients that pentavalent antimony given monthly prevents relapse in 93% of the patients during the first year, but if allopurinol is given alone the protection against relapse occurs only in 21% (244).…”

Section: Secondary Prophylaxismentioning

confidence: 99%

Leishmania and human immunodeficiency virus coinfection: the first 10 years

et al. 1997

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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 Leishmania-infected individuals without symptoms will express symptoms of leishmaniasis if they become immunosuppressed. However, there are indirect reasons and statistical data demonstrating that intravenous drug addiction plays a specific role in Leishmania infantum transmission: an anthroponotic cycle complementary to the zoonotic one has been suggested. Due to anergy in patients with coinfection, L. infantum dermotropic zymodemes are isolated from patient viscera and a higher L. infantum phenotypic variability is seen. Moreover, insect trypanosomatids that are currently considered nonpathogenic have been isolated from coinfected patients. HIV infection and Leishmania infection each induce important analogous immunological changes whose effects are multiplied if they occur concomitantly, such as a Th1-to-Th2 response switch; however, the consequences of the viral infection predominate. In fact, a large proportion of coinfected patients have no detectable anti-Leishmania antibodies. The microorganisms share target cells, and it has been demonstrated in vitro how L. infantum induces the expression of latent HIV-1. Bone marrow culture is the most useful diagnostic technique, but it is invasive. Blood smears and culture are good alternatives. PCR, xenodiagnosis, and circulating-antigen detection are available only in specialized laboratories. The relationship with low levels of CD4+ cells conditions the clinical presentation and evolution of disease. Most patients have visceral leishmaniasis, but asymptomatic, cutaneous, mucocutaneous, diffuse cutaneous, and post-kala-azar dermal leishmaniasis can be produced by L. infantum. The digestive and respiratory tracts are frequently parasitized. The course of coinfection is marked by a high relapse rate. There is a lack of randomized prospective treatment trials; therefore, coinfected patients are treated by conventional regimens. Prophylactic therapy is suggested to be helpful in preventing relapses.

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“…Allopurinol and fluconazole combinations have produced similar relapse rates (Torrus et al 1996). Itraconazole monotherapy has been reported in a single case report and subsequently in a case series of five patients where the mean period of remission was 2 years (Lafeuillade et al 1992; Angarano et al 1998).…”

Section: Discussionmentioning

confidence: 98%

Pentamidine as secondary prophylaxis for visceral leishmaniasis in the immunocompromised host: report of four cases

Patel

Lockwood

2009

Tropical Med Int Health

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SummaryWe report a retrospective and descriptive study of four immunocompromised patients (three with HIV-1 and one with idiopathic CD4+-lymphopenia) with relapsing visceral leishmaniasis seen at the Hospital for Tropical Diseases, London, in whom pentamidine was used as secondary prophylaxis to prevent relapse. Patients experienced between one and four relapses before commencing prophylaxis with subsequent relapse-free periods ranging from 5 to 98 months. Based on these observational data, we recommend large trials to investigate the efficacy of pentamidine over other agents in preventing relapse of VL in the immunocompromised patient.

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Maintenance itraconazole for visceral leishmaniasis in hiv infection

Cited by 21 publications

References 5 publications

Therapeutic Options for Visceral Leishmaniasis

Therapeutic Options for Visceral Leishmaniasis

Leishmania and human immunodeficiency virus coinfection: the first 10 years

Pentamidine as secondary prophylaxis for visceral leishmaniasis in the immunocompromised host: report of four cases

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