Prophylaxis of visceral leishmaniasis in human immunodeficiency virus-infected patients.
OBJECTIVE
To assess the effectiveness of two regimens with allopurinol or pentavalent antimony as secondary prophylaxis for visceral leishmaniasis (VL) in human immunodeficiency virus (HIV)-infected patients.


METHODS
Retrospective, nonrandomized, open trial.


METHODS
A 1,000-bed academic tertiary institutional hospital in Barcelona.


METHODS
Forty-six individuals over 14 years old with HIV infection, who recovered from an episode of VL between January 1988 and February 1995.


METHODS
Twenty patients did not receive any prophylaxis, nine received 300 mg/8 h of allopurinol, and 17 received 850 mg once-a-month of pentavalent antimony. Patients were followed-up every 3 months, and the endpoint of study was relapse of VL.


RESULTS
Twenty-one patients had recurrent VL: 13 of 20 in the control group (65%), 5 of 9 in the allopurinol group (56%), and 3 of 17 in the antimonial group (18%). Kaplan-Meier estimates of the probability of remaining relapse-free at 12 months were 9% without prophylaxis (95% CI, 0-22%), 21% with allopurinol (95% CI, 0-51%), and 93% with antimonials (95% CI, 82-100%) (P < 0.001). Multivariate analysis showed that the only significant variables related to relapsing course of VL were assignment to the antimonial group, and the fact that the patient had experienced a previous episode of VL.


CONCLUSIONS
Pentavalent antimony given once a month is effective in the prevention of VL relapses in HIV-infected individuals. It is a low-cost treatment that proved to be well tolerated. Therefore, pentavalent antimony should be considered a suitable agent for secondary prophylaxis against VL.
Ribera
E
E
Infectious Diseases Division, Hospitals Vall d'Hebron, Universidad Autonoma, Barcelona, Spain.
Ocaña
I
I
de Otero
J
J
Cortes
E
E
Gasser
I
I
Pahissa
A
A
D000328:Adult; D000368:Aged; D000493:Allopurinol / Q000008:administration & dosage / Q000627:therapeutic use*; D000818:Animals; D000965:Antimony; D000967:Antimony Sodium Gluconate / Q000008:administration & dosage / Q000627:therapeutic use*; D000981:Antiprotozoal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000517:prevention & control*; D008297:Male; D008536:Meglumine / Q000008:administration & dosage / Q000627:therapeutic use*; D000077485:Meglumine Antimoniate; D008875:Middle Aged; D015999:Multivariate Analysis; D009942:Organometallic Compounds / Q000008:administration & dosage / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors
D000981:Antiprotozoal Agents; D009942:Organometallic Compounds; D000493:Allopurinol; D008536:Meglumine; D000077485:Meglumine Antimoniate; D000965:Antimony; D000967:Antimony Sodium Gluconate