Efficacy of liposomal amphotericin B for secondary prophylaxis of visceral leishmaniasis in HIV-infected patients

Background and objectives: Visceral leishmaniasis ( VL) is characterized by frequent relapses in HIV-infected patients, even in those who receive secondary prophylaxis. The aim of our study was to evaluate the efficacy of liposomal amphotericin B ( L-AMB) for secondary prophylaxis of VL in HIV-infected patients. Methods: From January 2001 to December 2005, 17 HIV patients, with at least one previous episode of VL who received L-AMB as secondary prophylaxis for VL, were included in the study. Efficacy was measured as the proportion of patients remaining free ( non-relapse) of VL at different time points. Relapses were analysed as time-to-relapse distribution and were evaluated by survival analysis using the Kaplan-Meier method. Results: Twenty-one episodes of VL were diagnosed and nine relapsed. The median follow-up time was 14 ( 5-44) months. The probability of remaining free of relapse at 6 months was 89.7% ( 95% CI, 76.2-100); at 12 months, the probability was 79.1% ( 95% CI, 61-97.2) and at 24 and 36 months, the probability was 55.9% ( 95% CI, 30.5-81.3). In the non-relapsing group, patients had a significant increase in CD4 cell levels of 102 ( 10-174) and 126 ( 4-159) cells/mm(3) at 12 and 24 months, respectively ( P = 0.037), whereas in the relapsing group, no significant increase was observed. Prophylaxis with L-AMB was well tolerated and only three patients had a mild impairment of renal function without requiring any change in treatment. Conclusions: L-AMB is well tolerated and useful for secondary prophylaxis of VL.