Two cases of relapsed HIV-associated visceral leishmaniasis successfully treated with combination therapy

AIDS Res Ther. 2018 Dec 20;15(1):27. doi: 10.1186/s12981-018-0215-x.

Abstract

Background: The management of visceral leishmaniasis (VL) in HIV-infected patients is often complex with patients experiencing higher mortality rates, more toxic side effects and a higher possibility of treatment failure and relapse than HIV-negative individuals with VL.

Case presentation: We report on successful salvage therapy in two HIV-infected patients suffering with disseminated cutaneous and visceral leishmaniasis, recalcitrant to therapy with liposomal amphotericin B. After the employment of combination anti-leishmanial treatment, parasite genomes were not detectable up to the last follow up visit, 57 and 78 weeks after treatment onset, respectively. CD4+ lymphocyte counts fluctuated over time, but were generally higher than counts detected at treatment onset, which likely contributed to protection against VL relapse.

Conclusions: Results achieved with the anti-leishmanial combination treatment were promising, but are based on only two patients. Future investigation is necessary to confirm the efficacy of this salvage therapy in sustaining the immunological response and control of VL.

Keywords: Disseminated cutaneous leishmaniasis; Opportunistic infection; Protozoal infection; Visceral leishmaniasis.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-HIV Agents / therapeutic use*
  • Antiprotozoal Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active
  • Coinfection / drug therapy*
  • Drug Therapy, Combination
  • Female
  • HIV Infections / diagnosis
  • HIV Infections / drug therapy*
  • HIV Infections / virology
  • HIV-1 / genetics
  • Humans
  • Leishmania donovani / genetics
  • Leishmaniasis, Visceral / diagnosis
  • Leishmaniasis, Visceral / drug therapy*
  • Leishmaniasis, Visceral / parasitology
  • Male
  • Middle Aged
  • Polymerase Chain Reaction
  • Treatment Outcome

Substances

  • Anti-HIV Agents
  • Antiprotozoal Agents