title: Liposomal amphotericin B for visceral leishmaniasis in human immunodeficiency virus-coinfected patients: 2-year treatment outcomes in Bihar, India.
abstract: BACKGROUND
  Reports on treatment outcomes of visceral leishmaniasis (VL)-human immunodeficiency virus (HIV) coinfection in India are lacking. To our knowledge, none have studied the efficacy of liposomal amphotericin B in VL-HIV coinfection. We report the 2-year treatment outcomes of VL-HIV-coinfected patients treated with liposomal amphotericin B followed by combination antiretroviral treatment (cART) in Bihar, India.
  
  
  METHODS
  The study included all patients with newly diagnosed VL-HIV coinfection and initiating treatment with liposomal amphotericin B (20-25 mg/kg in 4-15 days) between July 2007 and September 2010. Kaplan-Meier estimates of the cumulative incidence of death/treatment failure were calculated.
  
  
  RESULTS
  Fifty-five patients were included (83.6% male; median age, 35 years; 62% migrant laborers; median follow-up, 1 year). The median CD4 cell count at VL diagnosis was 66 cells/μL (interquartile range, 38-112). Twenty-seven patients (49.1%) presented with VL relapse of VL. The overall tolerance of liposomal amphotericin B was excellent, with no interrupted treatment. Survival by 1 and 2 years after VL treatment was estimated at 85.5%. No patients had initial treatment failure. The probabilities of VL relapse were 0%, 8.1%, and 26.5% at 0.5, 1, and 2 years after VL treatment, respectively; relapse rates were similar for primary VL and VL relapse. CD4 counts <200 cells/μL at 6 months after cART initiation were predictive of subsequent relapse. The mean CD4 cell counts at 6 and 24 months after cART initiation were 187 and 261 cells/μL, respectively. The rate for retention in HIV care was 83.6%.
  
  
  CONCLUSIONS
  Good long-term survival and retention rates were obtained for VL-HIV-coinfected patients treated with liposomal amphotericin B and cART. Although the initial VL treatment response was excellent, VL relapse within 2 years remained frequent.
authors: Rajendra Memorial Research Institute of Medical Science, Patna, Bihar.
authors: Prabhat K
authors: PK
authors: Sinha
authors: Johan
authors: J
authors: van Griensven
authors: Krishna
authors: K
authors: Pandey
authors: Nawin
authors: N
authors: Kumar
authors: Neena
authors: N
authors: Verma
authors: Raman
authors: R
authors: Mahajan
authors: Pankaj
authors: P
authors: Kumar
authors: Ranjeet
authors: R
authors: Kumar
authors: Pradeeb
authors: P
authors: Das
authors: Gaurab
authors: G
authors: Mitra
authors: Laurence
authors: L
authors: Flevaud
authors: Cecilia
authors: C
authors: Ferreyra
authors: Daniel
authors: D
authors: Remartinez
authors: Manuel
authors: M
authors: Pece
authors: Pedro Pablo
authors: PP
authors: Palma
mesh_terms: D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage*; D019380:Anti-HIV Agents / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D007194:India; D007898:Leishmaniasis, Visceral / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D012008:Recurrence; D016019:Survival Analysis; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B