[Liposomal amphotericin B in secondary prophylaxis of visceral leishmaniasis in HIV-infected patients: report of five clinical cases].
Treatment of visceral leishmaniasis in HIV patients encounters inefficacy and relapse due to drug resistance, toxicity and immunodepression. Our goal was to evaluate treatment of these patients by liposomal amphotericin B (L-AmB). Since 1998, five clinical files were exploitable out of 13 patients. Protocols used bolus doses ranging between 2.9 and 4.1 mg/kg dispatched on 5-24 days, followed by maintenance dose ranging from 2.7 to 3.8 mg/kg every 15 days. Attack treatment involved high bolus dose (cumulated doses ranging from 60 to 86 mg/kg at day 30) and allowed favorable clinical and biological results with healing in four patients. Secondary prophylaxis with L-AmB has been efficacious and well tolerated in three patients. Although literature and study results cannot indicate a standard therapeutic care in these patients, an initial treatment by L-AmB at doses higher than marketing-approved doses with a secondary prophylaxis by L-AmB associated with an antiretroviral treatment seem to be major asset in order to obtain healing. Expanding this study to a multicenter trial should allow to better define the frequency and duration of the secondary prophylaxis and to evaluate the risk of therapeutic escape as well as the life-span increase.
Montana
M
M
Pharmacie, CHU de la Conception, 147, boulevard Baille, 13005 Marseille, France. montanamarc@hotmail.com
Chochoi
N
N
Monges
P
P
Ravaux
I
I
Faraut
F
F
Gensollen
S
S
Bongrand
M C
MC
Timon-David
P
P
Gallais
H
H
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use*; D000818:Animals; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D004338:Drug Combinations; D004341:Drug Evaluation; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D018314:Leishmania infantum; D007898:Leishmaniasis, Visceral / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008536:Meglumine / Q000627:therapeutic use; D000077485:Meglumine Antimoniate; D009942:Organometallic Compounds / Q000627:therapeutic use; D010713:Phosphatidylcholines / Q000627:therapeutic use; D010715:Phosphatidylglycerols / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D015819:Substance Abuse, Intravenous / Q000150:complications; D016896:Treatment Outcome
D000981:Antiprotozoal Agents; D004338:Drug Combinations; D009942:Organometallic Compounds; D010713:Phosphatidylcholines; D010715:Phosphatidylglycerols; C068538:liposomal amphotericin B; D008536:Meglumine; D000077485:Meglumine Antimoniate; D000666:Amphotericin B