title: Protective Efficacy of Secondary Prophylaxis Against Visceral Leishmaniasis in Human Immunodeficiency Virus Coinfected Patients Over the Past 10 Years in Eastern India.
abstract: Coinfection with visceral leishmaniasis (VL) and human immunodeficiency virus (HIV) leads to frequent treatment failure, relapse, and death. In this retrospective analysis from eastern India (2005-2015), our primary objective was to ascertain the protective efficacy of secondary prophylaxis with monthly amphotericin B (AmB) given in patients with HIV-VL coinfection toward reducing relapse and mortality rates. The secondary objective was to compare clinical features, laboratory findings, and treatment outcomes in HIV-VL patients in contrast to VL monoinfection. Overall, 53 cases of HIV-VL and 460 cases of VL monoinfection were identified after excluding incomplete records. Initial cure rate was 96.23% in HIV-VL (27 received liposomal AmB and 26 AmB deoxycholate). All patients with initial cure (N= 51) were given antiretroviral therapy. Secondary prophylaxis (N= 27) was provided with monthly 1 mg/kg AmB (15 liposomal, 12 deoxycholate). No relapse or death was noted within 6 months in the secondary prophylaxis group (relapse: none versus 18/24 [75%]; mortality: none versus 11/24 [45.8%];P< 0.001 for both). Secondary prophylaxis remained the sole significant predictor against death in multivariate Cox regression model (hazard ratio = 0.09 [95% confidence interval = 0.03-0.31];P< 0.001). HIV-VL patients had higher 6-month relapse rate, less relapse-free 12-month survival, and higher mortality (P< 0.001 each) than VL monoinfection. In conclusion, it appears from this study that secondary prophylaxis with monthly AmB might be effective in preventing relapse and mortality in HIV-VL.
authors.affiliation: Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India.
authors.forename: Rama P
authors.initials: RP
authors.lastname: Goswami
authors.affiliation: Department of Rheumatology, Institution of Post Graduate Medical Education and Research, Kolkata, India. rudra.goswami@gmail.com.
authors.forename: Rudra P
authors.initials: RP
authors.lastname: Goswami
authors.affiliation: Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India.
authors.forename: Ayan
authors.initials: A
authors.lastname: Basu
authors.affiliation: Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India.
authors.forename: Yogiraj
authors.initials: Y
authors.lastname: Ray
authors.affiliation: Department of Tropical Medicine, School of Tropical Medicine, Kolkata, India.
authors.forename: Mehebubar
authors.initials: M
authors.lastname: Rahman
authors.affiliation: Department of Clinical and Experimental Pharmacology, School of Tropical Medicine, Kolkata, India.
authors.forename: Santanu K
authors.initials: SK
authors.lastname: Tripathi
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D060085:Coinfection / Q000517:prevention & control*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000469:parasitology; D006801:Humans; D007194:India; D007898:Leishmaniasis, Visceral / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control*; D008297:Male; D012189:Retrospective Studies; D055502:Secondary Prevention / Q000379:methods
chemical_list: D000981:Antiprotozoal Agents; D000666:Amphotericin B