Long term outcomes and prognostics of visceral leishmaniasis in HIV infected patients with use of pentamidine as secondary prophylaxis based on CD4 level: A prospective cohort study in Ethiopia

by Diro E, Edwards T, Ritmeijer K, Fikre H, Abongomera C, Kibret A, Bardonneau C, Soipei P, Mutinda B, Omollo R, van Griensven J, Zijlstra EE, Wasunna M, Alves F, Alvar J, Hailu A, Alexander N, Blesson SPLOS Neglected Tropical Diseases 2019, 13(2): e0007132. doi: 

Summary: The long-term treatment outcome of visceral leishmaniasis (VL) patients with HIV co-infection is complicated by a high relapse rate, especially when the CD4 count is low. The one-year relapse-free survival rate in this cohort study to determine the safety and effectiveness of secondary prophylaxis in coinfected patients was 50%. Monthly pentamidine infusion for those with lower CD4 counts (<200 cells/μL) at the time of VL cure resulted in a relapse-free survival rate comparable to those with higher CD4 count (≥200 cells/μL) who did not receive secondary prophylaxis. While all HIV-VL patients may benefit from secondary prophylaxis, patients with CD4 <200 cells/μL and those with a previous history of treatment (who are at higher risk for subsequent relapse) should be prioritized.

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