title: Combination Treatment for Visceral Leishmaniasis Patients Coinfected with Human Immunodeficiency Virus in India.
abstract: BACKGROUND
  There are considerable numbers of patients coinfected with human immunodeficiency virus (HIV) and visceral leishmaniasis (VL) in the VL-endemic areas of Bihar, India. These patients are at higher risk of relapse and death, but there are still no evidence-based guidelines on how to treat them. In this study, we report on treatment outcomes of coinfected patients up to 18 months following treatment with a combination regimen.
  
  
  METHODS
  This retrospective analysis included all patients with confirmed HIV-VL coinfection receiving combination treatment for VL at a Médecins Sans Frontières treatment center between July 2012 and September 2014. Patients were treated with 30 mg/kg body weight intravenous liposomal amphotericin B (AmBisome) divided as 6 equal dose infusions combined with 14 days of 100 mg/day oral miltefosine (Impavido). All patients were encouraged to start or continue on antiretroviral therapy (ART).
  
  
  RESULTS
  102 patients (76% males, 57% with known HIV infection, 54% with a prior episode of VL) were followed-up for a median of 11 months (interquartile range: 4-18). Cumulative incidence of all-cause mortality and VL relapse at 6, 12, and 18 months was 11.7%, 14.5%, 16.6% and 2.5%, 6.0%,13.9%, respectively. Cumulative incidence of poor outcome at 6, 12, and 18 months was 13.9%, 18.4%, and 27.2%, respectively. Not initiating ART and concurrent tuberculosis were independent risk factors for mortality, whereas no factors were associated with relapse.
  
  
  CONCLUSIONS
  In this Bihar-based study, combination therapy appeared to be well tolerated, safe, and effective and may be considered as an option for treatment of VL in HIV coinfected patients.
authors.affiliation: Médecins Sans Frontières, New Delhi.
authors.forename: Raman
authors.initials: R
authors.lastname: Mahajan
authors.affiliation: Rajendra Mamorial Research Institute, Patna, India.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Das
authors.affiliation: Médecins Sans Frontières, Research Unit, Luxembourg.
authors.forename: Petros
authors.initials: P
authors.lastname: Isaakidis
authors.affiliation: Médecins Sans Frontières, New Delhi.
authors.forename: Temmy
authors.initials: T
authors.lastname: Sunyoto
authors.affiliation: International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India.
authors.forename: Karuna D
authors.initials: KD
authors.lastname: Sagili
authors.affiliation: Médecins Sans Frontières, Barcelona, Spain.
authors.forename: Marıa Angeles
authors.initials: MA
authors.lastname: Lima
authors.affiliation: Médecins Sans Frontières, New Delhi.
authors.forename: Gaurab
authors.initials: G
authors.lastname: Mitra
authors.affiliation: Médecins Sans Frontières, New Delhi.
authors.forename: Deepak
authors.initials: D
authors.lastname: Kumar
authors.affiliation: Rajendra Mamorial Research Institute, Patna, India.
authors.forename: Krishna
authors.initials: K
authors.lastname: Pandey
authors.affiliation: International Health, University of Antwerp.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Van Geertruyden
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Marleen
authors.initials: M
authors.lastname: Boelaert
authors.affiliation: Médecins Sans Frontières, New Delhi Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Sakib
authors.initials: S
authors.lastname: Burza
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage* / Q000627:therapeutic use; D060085:Coinfection; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality / Q000821:virology; D006801:Humans; D007194:India; D007898:Leishmaniasis, Visceral / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D010767:Phosphorylcholine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C068538:liposomal amphotericin B; D010767:Phosphorylcholine; C039128:miltefosine; D000666:Amphotericin B
keywords: AmBisome; HIV; combination treatment; miltefosine; visceral leishmaniasis