Visceral leishmaniasis in HIV infected patients: Treatment with high dose liposomal amphotericin B (AmBisome)

Russo, R; Nigro, Luciano; Minniti, S; Montineri, Arturo; Gradoni, Luigi; Caldeira, L.; Davidson, Robert N.

doi:10.1016/s0163-4453(96)91343-2

Cited by 82 publications

(40 citation statements)

References 19 publications

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“…Cases of relapses following AmBisome treatment were found in immunocompromised patients, in AIDS patients in Europe with VL caused by L. infantum (Russo et al, 1996), in children under 5 years old with Brazilian VL (due to L. chagasi), and, more exceptionally, in Indian kala-azar (Berman, 2003(Berman, , 2005Davidson and Russo, 1994;Freire et al, 1997;Montana et al, 2004).…”

Section: Discussionmentioning

confidence: 99%

Unresponsiveness to AmBisome in some Sudanese patients with kala-azar

Mueller

Ritmeijer

Balasegaram

et al. 2007

Transactions of the Royal Society of Tropical Medicine and Hygi

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SummaryIn Sudan, two treatments are currently registered for visceral leishmaniasis: sodium stibogluconate (SSG) as first line and liposomal amphotericin B (AmBisome) as second line. We present 64 patients (52 relapse cases to SSG, 12 new but complicated cases) treated with AmBisome in eastern Sudan. AmBisome was administered at 2.5-8.2 mg/kg (15-49 mg/kg in total) per dose six times (days 1, 2, 3, 5, 10, 15) as an intravenous infusion. We measured outcome according to clinical response and parasitological clearance (lymph node aspiration). Patient outcomes fell into three groups: group 1, clinical responders (cured) with a negative test of cure (n = 35); group 2, clinical responders with a positive test of cure (n = 19); group 3, clinical non-responders (failures) with a positive test of cure (n = 10). Of the 10 failures, six were already relapse cases. All of group 3, and 15 from group 2, were also treated with additional SSG (20 mg/kg intramuscularly daily for 30-50 d) with resulting clinical and parasitological improvement. Parasite persistence and clinical failure were associated with a higher parasite density on admission (P < 0.002) and underlying immunosuppressive disease: tuberculosis (three cases) or HIV (two cases). Because AmBisome monotherapy may fail in Sudan, a combination of AmBisome and SSG is recommended for relapse cases.

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Section: Discussionmentioning

confidence: 99%

Unresponsiveness to AmBisome in some Sudanese patients with kala-azar

Mueller

Ritmeijer

Balasegaram

et al. 2007

Transactions of the Royal Society of Tropical Medicine and Hygi

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“…28 The simultaneous, irreversible production of low levels of IFN-␥ and large amounts of IL-4 may be responsible for drug resistance to Leishmania, as well as for relapsing visceral infection, which are both typical clinical features of VL in HIV-seropositive individuals. 29 More recent availability of highly active antiretroviral drug combinations could favor an immunologic response with a reversal from type 2 to type 1 cytokines in HIVinfected individuals and probably enhance the efficacy of anti-leishmanial drugs in those who are coinfected with HIV and Leishmania.…”

Section: Discussionmentioning

confidence: 99%

In vitro production of type 1 and type 2 cytokines by peripheral blood mononuclear cells from subjects coinfected with human immunodeficiency virus and Leishmania infantum.

Nigro

Cacopardo²,

Preiser³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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“…This was thought to be related to high initial parasite loads and immunosuppressing underlying diseases (HIV infection and tuberculosis), and it was suggested that higher doses should have been used (165). In Europe, total doses of up to 30 to 40 mg/kg have been evaluated in small numbers of coinfected patients and were well tolerated, but they did not prevent relapses (73,226). A dosing recommendation for coinfected patients cannot be made based on the limited data available.…”

Section: Treatment Of Leishmaniasis In Hiv-positive Patientsmentioning

confidence: 99%

The Relationship between Leishmaniasis and AIDS: the Second 10 Years

et al. 2008

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SUMMARY To date, most Leishmania and human immunodeficiency virus (HIV) coinfection cases reported to WHO come from Southern Europe. Up to the year 2001, nearly 2,000 cases of coinfection were identified, of which 90% were from Spain, Italy, France, and Portugal. However, these figures are misleading because they do not account for the large proportion of cases in many African and Asian countries that are missed due to a lack of diagnostic facilities and poor reporting systems. Most cases of coinfection in the Americas are reported in Brazil, where the incidence of leishmaniasis has spread in recent years due to overlap with major areas of HIV transmission. In some areas of Africa, the number of coinfection cases has increased dramatically due to social phenomena such as mass migration and wars. In northwest Ethiopia, up to 30% of all visceral leishmaniasis patients are also infected with HIV. In Asia, coinfections are increasingly being reported in India, which also has the highest global burden of leishmaniasis and a high rate of resistance to antimonial drugs. 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.

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Visceral leishmaniasis in HIV infected patients: Treatment with high dose liposomal amphotericin B (AmBisome)

Cited by 82 publications

References 19 publications

Unresponsiveness to AmBisome in some Sudanese patients with kala-azar

Unresponsiveness to AmBisome in some Sudanese patients with kala-azar

In vitro production of type 1 and type 2 cytokines by peripheral blood mononuclear cells from subjects coinfected with human immunodeficiency virus and Leishmania infantum.

The Relationship between Leishmaniasis and AIDS: the Second 10 Years

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