Treatment of Visceral Leishmaniasis with Concurrent HIV/AIDS

When visceral leishmaniasis (VL) occurs in a person with concurrent HIV/AIDS, the immunocompromised state shapes which treatment is appropriate and how the overall management is structured.

Clinical Scenario

This protocol applies to visceral leishmaniasis in the setting of active HIV/AIDS — a coinfection in which immunocompromise affects both the severity of VL and the choice of antileishmanial treatment. Management of both conditions must be considered together.

Treatment Approach (Partial Overview)

For immunocompromised persons with VL, including those with concurrent HIV/AIDS, a liposomal antileishmanial agent administered intravenously is recommended. Alongside antileishmanial therapy, antiretroviral therapy (ART) initiation or optimization is an important part of the overall approach — the complete schedule, sequencing, and clinical decision points are available in the full protocol.

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References

DOI: 10.4269/ajtmh.16-84256

Liposomal amphotericin B (L-AmB) is recommended for the treatment of VL in immunocompromised persons in North America (Table 3).
The FDA-approved dosage regimen of L-AmB for such persons, including those with concurrent HIV/AIDS, is 4 mg/kg/day IV, on days 1–5, 10, 17, 24, 31, and 38 (10 doses over a 38-day period), for a total dose of 40 mg/kg.
Because of the importance of effective immune reconstitution in HIV-VL-coinfected persons, antiretroviral therapy (ART) should be initiated or optimized as soon as the person is sufficiently stable to tolerate it (e.g., either during or soon after the initial course of therapy for VL).

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