Meglumine antimoniate combination treatment for relapsing Kala-azar after treatment and secondary prophylaxis failure with liposomal amphotericin B in two HIV-coinfected patients

What is it about?

Visceral Leishmaniasis is a protozoan infection caused by Leishmania infantum and Leishmania donovani with a higher incidence and severity in HIV infected patients due to its synergistic effect on hampering the immune response, often leading to death after treatment failure. Literature regarding the management of relapsing Visceral Leishmaniasis in HIV co-infected patients is lacking. Many experts recommend a combined therapy with lipossomal amphotericin B and miltefosine. The use of pentavalent antimonials is often discouraged due to their toxicity. We report two cases of a successful response to treatment with combined therapy with meglumine antimoniate followed by secondary prophyaxis with miltefosine and atovaquone on relapsing Visceral Leishmaniasis in two HIV-co-infected patients despite treatment and monthly prophylaxis with appropriate doses of lipossomal amphotericin B.

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