Use of pentamidine as secondary prophylaxis to prevent visceral leishmaniasis relapse in HIV-infected patients, the first twelve months of a prospective cohort study

by Diro E, Ritmeijer K, Boelaert M, Alves F, Mohammed R, Abongomera C, Ravinetto R, De Crop M, Fikre H, Adera C, Colebunders R, van Loen H, Menten J, Lynen L, Hailu A, van Griensven J. PLoS Neglected Tropical Diseases. 2015 Oct 2;9(10):e0004087. doi: 10.1371/journal.pntd.0004087. eCollection 2015.

Summary: Visceral leishmaniasis (VL) has become an important opportunistic infection in persons with HIV-infection in VL-endemic areas. The co-infection leads to profound immunosuppression and high rate of annual VL recurrence. This study, carried out in Ethiopia, assessed the effectiveness, safety and feasibility of monthly pentamidine infusions to prevent recurrence of VL in co-infected patients. Pentamidine secondary prophylaxis led to a 29% failure rate within one year, much lower than reported in historical controls (50%-100%). Patients with low CD4+cell counts are at increased risk of relapse despite effective initial VL treatment, ART and secondary prophylaxis. VL should be detected and treated early enough in patients with HIV infection before profound immune deficiency installs.

Click here to read article / PDF