Limited Effectiveness of High-Dose Liposomal Amphotericin B (AmBisome) for Treatment of Visceral Leishmaniasis in an Ethiopian Population With High HIV Prevalence
Open Access
- 19 October 2011
- journal article
- research article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 53 (12), e152-e158
- https://doi.org/10.1093/cid/cir674
Abstract
Background. Due to unacceptably high mortality with pentavalent antimonials, Médecins Sans Frontières in 2006 began using liposomal amphotericin B (AmBisome) for visceral leishmaniasis (VL) patients in Ethiopia who were severely ill or positive for human immunodeficiency virus (HIV). Methods. We used clinical data obtained from January 2007 to January 2009 to compare outcomes by HIV status and VL episode (primary vs relapse) and to identify risk factors for treatment failure among patients treated with AmBisome monotherapy at a total dose of 30 mg/kg in 6 doses on alternate days, a higher dose than recommended by the World Health Organization (20 mg/kg). Results. Among 94 HIV-negative severely ill VL patients, 93% had initial cure and 6% died. Among 195 HIV-positive patients (116 primary, 79 relapse VL), 60% had initial cure, 7% died, and 32% were parasitological failures. AmBisome was less effective in the 79 HIV-positive VL relapse patients (38% initial cure, 5% mortality, 56% parasitological failure) than in the 116 HIV-positive primary VL patients (74% initial cure, 8% mortality, 16% parasitological failure). Sodium stibogluconate (SSG) rescue treatment increased the overall cure rate among all HIV-positive VL patients from 60% to 83%, but 16% (9 of 59) of rescue treatment patients died, mainly due to SSG toxicity. Conclusions. High-dose AmBisome for VL is safe and effective in severely ill HIV-negative patients, and safe but less effective in HIV-positive patients. Combining AmBisome with another drug may enhance its effectiveness in HIV-positive VL patients. SSG should be avoided for treatment of VL in HIV-positive patients.Keywords
This publication has 31 references indexed in Scilit:
- Geographical Variation in the Response of Visceral Leishmaniasis to Paromomycin in East Africa: A Multicentre, Open-Label, Randomized TrialPLoS Neglected Tropical Diseases, 2010
- Field Evaluation of rK39 Test and Direct Agglutination Test for Diagnosis of Visceral Leishmaniasis in a Population with High Prevalence of Human Immunodeficiency Virus in EthiopiaThe American Journal of Tropical Medicine and Hygiene, 2009
- Treatment of Kala-Azar in Southern Sudan using a 17-Day Regimen of Sodium Stibogluconate Combined with Paromomycin: A Retrospective Comparison with 30-Day Sodium Stibogluconate MonotherapyThe American Journal of Tropical Medicine and Hygiene, 2007
- A Comparison of Miltefosine and Sodium Stibogluconate for Treatment of Visceral Leishmaniasis in an Ethiopian Population with High Prevalence of HIV InfectionClinical Infectious Diseases, 2006
- Conflict and Kala‐Azar: Determinants of Adverse Outcomes of Kala‐Azar among Patients in Southern SudanClinical Infectious Diseases, 2004
- Visceral leishmaniasis and HIV in Tigray, EthiopiaTropical Medicine & International Health, 2003
- Ethiopian visceral leishmaniasis: generic and proprietary sodium stibogluconate are equivalent; HIV co-infected patients have a poor outcomeTransactions of the Royal Society of Tropical Medicine and Hygiene, 2001
- A randomized comparison of branded sodium stibogluconate and generic sodium stibogluconate for the treatment of visceral leishmaniasis under field conditions in SudanTropical Medicine & International Health, 2000
- Leishmania and human immunodeficiency virus coinfection: the first 10 yearsClinical Microbiology Reviews, 1997
- The Epidemic of Visceral Leishmaniasis in Western Upper Nile, Southern Sudan: Course and Impact from 1984 to 1994International Journal of Epidemiology, 1996