Treatment of Visceral Leishmaniasis in Immunosuppressed Patients (Non-HIV)

Visceral leishmaniasis (VL) in an immunosuppressed host who is not coinfected with HIV requires a distinct treatment approach. This protocol targets patients whose immunocompromised state arises from solid organ transplantation, a lymphatic or hematologic malignancy, or ongoing immunosuppressive therapy.

Clinical Scenario

This protocol applies when VL occurs in a patient with one of the following conditions:

Solid organ transplant recipient
Lymphatic or hematologic malignancy
Receiving immunosuppressive therapy for any other indication

Compared to HIV-coinfected persons, immunosuppressed non-HIV patients with VL typically show higher response rates to initial treatment and lower recurrence rates.

Treatment Approach

A liposomal antileishmanial agent is recommended as the drug of choice for this immunosuppressed population, with adjustment of the patient's concurrent immunosuppressive medications representing a critical component of overall management.

The complete structured regimen — including the full dosing schedule and guidance on immunosuppression management — is available in the protocol below.

Instant Access to Structured Evidence-Based Regimens

References

What is the preferred treatment of visceral/cutaneous leishmaniasis in immunocompromised hosts with solid organ transplant, persons with lymphatic-hematologic malignancies, or persons receiving immunosuppressive therapy for other reasons?
Immunosuppressed persons with VL who are not coinfected with HIV typically have higher response rates to initial treatment and lower recurrence rates than HIV-coinfected persons.
Liposomal amphotericin B (L-AmB) is recommended as the drug of choice for immunosuppressed persons with VL (Table 3).
Doses of immunosuppressive drugs should be decreased in persons with VL during antileishmanial therapy whenever possible.

DOI: 10.4269/ajtmh.16-84256

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