Leishmania infection can hamper immune recovery in virologically suppressed HIV-infected patients.
An HIV-infected patient started combination antiretroviral therapy with 13 CD4+ cells/microL. Despite sustained virological suppression over the following four years, the anemia did not resolve, and the CD4+ cell counts always remained below 200/microL until co-infection with Leishmania was diagnosed in October 2006 when the patient started complaining of persistent mild fever and asthenia. Once treatment for leishmaniasis was started with miltefosine, CD4+ cell count rose above 400/microL. A new drop in CD4+ cell count was observed when Leishmania DNA turned out again to be positive, but treatment with liposomal amphotericin-B restored immune recovery.
Division of Infectious Diseases, IRCCS San Raffaele, Milan, Italy. nicola.gianotti@hsr.it
Nicola
N
Gianotti
Myriam
M
Maillard
Giovanni
G
Gaiera
Arabella
A
Bestetti
Massimo
M
Cernuschi
Anna
A
De Bona
Adriano
A
Lazzarin
Paola
P
Cinque
Simona
S
Bossolasco
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D007896:Leishmaniasis / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D008297:Male; D010767:Phosphorylcholine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use
D044966:Anti-Retroviral Agents; D000981:Antiprotozoal Agents; C068538:liposomal amphotericin B; D010767:Phosphorylcholine; C039128:miltefosine; D000666:Amphotericin B