This protocol addresses visceral leishmaniasis (VL) in patients who are immunocompetent — confirmed to have no identified congenital or acquired immune defect — and who meet clinical and laboratory criteria for treatment.
Patients presenting with clinical abnormalities compatible with VL, supported by laboratory evidence, should be treated. Immunocompetent status is defined as the absence of any congenital or acquired immune deficiency, including HIV/AIDS. This distinction shapes the choice and structure of the therapeutic approach.
Treatment in this setting may involve L-AmB or an alternative agent, with combination strategies a further consideration in select cases.
Specific agent selection, sequencing, and full regimen details are available in the structured protocol below.DOI: 10.4269/ajtmh.16-84256
We recommend that persons with clinical abnormalities compatible with VL and laboratory evidence of VL be treated (Table 3).
An immunocompetent person is defined as someone without an identified congenital or acquired immune defect (eg, HIV/AIDS).
Immunocompetent persons with VL who do not respond to therapy with L-AmB should be treated with an alternative drug or with a higher dose or a longer course of L-AmB.
Immunocompetent persons with VL who respond to initial therapy but subsequently have a relapse should be treated with an alternative drug or with another, potentially longer, course of therapy with the initial drug. If L-AmB was the drug used for initial therapy, use of a higher dose can be considered.
Combination therapies may be considered but have not been well studied after therapeutic failure in persons with VL.
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