Treatment of Visceral Leishmaniasis with Concurrent HIV/AIDS
Patients living with HIV/AIDS who develop visceral leishmaniasis (VL) represent a clinically complex population. Immunosuppression from HIV/AIDS alters the natural course of VL and complicates treatment, requiring approaches tailored to this immunocompromised setting.
Clinical Scenario
This protocol addresses visceral leishmaniasis in persons with concurrent HIV/AIDS. The co-existence of HIV-related immunocompromise and active VL infection defines the management challenge and shapes the choice of therapeutic strategy.
Persons with HIV/AIDS require dedicated therapeutic consideration for VL, and established guidance from North American authorities specifically addresses this immunocompromised population.
Treatment Approach
Partial overview — full regimen in protocol
Management in this setting may involve combination antileishmanial therapy for refractory presentations, or retreatment strategies when initial therapy has not achieved the desired clinical response. Additional options may be considered in select patients under close follow-up. The complete regimen — including agent selection, sequencing, and all clinical decision points — is available in the structured protocol below.
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.
- Combination therapy (e.g., L-AmB plus miltefosine) might be considered, especially for persons with refractory cases of VL.
- Confirmed VL therapeutic failure typically can be managed by retreatment using L-AmB at the same or a higher total dose.
- Pentavalent antimonials could be used in some persons with VL under close follow-up.
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