title: AA-amyloidosis caused by visceral leishmaniasis in a human immunodeficiency virus-infected patient.
abstract: AA-amyloidosis in the setting of chronic visceral leishmaniasis (VL) has been reported in animal models but documentation in humans is unavailable. Here, we report on a Portuguese man who in 1996 was diagnosed with both human immunodeficiency virus (HIV)-infection and VL. Antiretroviral treatment led to sustained suppression of HIV viremia but CD4+ lymphocytes rose from 8 to only 160 cells/mL. Several courses of antimony treatment did not prevent VL relapses. Renal failure developed in 2006 and renal biopsy revealed AA-amyloidosis. The patient had cryoglobulinemia and serum immune complexes containing antibodies directed against seven leishmanial antigens. Antimony plus amphotericin B, followed by oral miltefosine resulted in a sustained VL treatment response with elimination of circulating Leishmania infantum DNA and CD4+ recovery. The concomitant reduction of serum AA levels and disappearance of circulating leishmanial immune complexes suggests that prolonged VL may lead to AA-amyloidosis in immunocompromised humans.
authors.affiliation: Infectious Diseases Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
authors.forename: Serge
authors.initials: S
authors.lastname: de Vallière
authors.forename: Charles
authors.initials: C
authors.lastname: Mary
authors.forename: Jeanna E
authors.initials: JE
authors.lastname: Joneberg
authors.forename: Samuel
authors.initials: S
authors.lastname: Rotman
authors.forename: Roberto
authors.initials: R
authors.lastname: Bullani
authors.forename: Gilbert
authors.initials: G
authors.lastname: Greub
authors.forename: Julian D
authors.initials: JD
authors.lastname: Gillmore
authors.forename: Pierre A
authors.initials: PA
authors.lastname: Buffet
authors.forename: Philip E
authors.initials: PE
authors.lastname: Tarr
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000686:Amyloidosis / Q000150:complications*; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008536:Meglumine / Q000627:therapeutic use; D000077485:Meglumine Antimoniate; D009942:Organometallic Compounds / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D000981:Antiprotozoal Agents; D009942:Organometallic Compounds; D008536:Meglumine; D000077485:Meglumine Antimoniate; D000666:Amphotericin B