Rajendra Memorial Research Institute of Medical Science, Patna, Bihar.
Clin Infect Dis. 2011 Oct;53(7):e91-8. doi: 10.1093/cid/cir521.
Reports on treatment outcomes of visceral leishmaniasis (VL)-human immunodeficiency virus (HIV) coinfection in India are lacking. To our knowledge, none have studied the efficacy of liposomal amphotericin B in VL-HIV coinfection. We report the 2-year treatment outcomes of VL-HIV-coinfected patients treated with liposomal amphotericin B followed by combination antiretroviral treatment (cART) in Bihar, India.
The study included all patients with newly diagnosed VL-HIV coinfection and initiating treatment with liposomal amphotericin B (20-25 mg/kg in 4-15 days) between July 2007 and September 2010. Kaplan-Meier estimates of the cumulative incidence of death/treatment failure were calculated.
Fifty-five patients were included (83.6% male; median age, 35 years; 62% migrant laborers; median follow-up, 1 year). The median CD4 cell count at VL diagnosis was 66 cells/μL (interquartile range, 38-112). Twenty-seven patients (49.1%) presented with VL relapse of VL. The overall tolerance of liposomal amphotericin B was excellent, with no interrupted treatment. Survival by 1 and 2 years after VL treatment was estimated at 85.5%. No patients had initial treatment failure. The probabilities of VL relapse were 0%, 8.1%, and 26.5% at 0.5, 1, and 2 years after VL treatment, respectively; relapse rates were similar for primary VL and VL relapse. CD4 counts <200 cells/μL at 6 months after cART initiation were predictive of subsequent relapse. The mean CD4 cell counts at 6 and 24 months after cART initiation were 187 and 261 cells/μL, respectively. The rate for retention in HIV care was 83.6%.
Good long-term survival and retention rates were obtained for VL-HIV-coinfected patients treated with liposomal amphotericin B and cART. Although the initial VL treatment response was excellent, VL relapse within 2 years remained frequent.
印度内脏利什曼病（VL）-人类免疫缺陷病毒（HIV）合并感染的治疗结果报告较为缺乏。据我们所知，尚无研究报道脂质体两性霉素 B 在 VL-HIV 合并感染中的疗效。我们报告了在印度比哈尔邦，接受脂质体两性霉素 B 治疗后再接受联合抗逆转录病毒治疗（cART）的 VL-HIV 合并感染患者的 2 年治疗结果。
该研究纳入了所有 2007 年 7 月至 2010 年 9 月期间新诊断为 VL-HIV 合并感染并开始接受脂质体两性霉素 B（20-25mg/kg，4-15 天）治疗的患者。采用 Kaplan-Meier 估计法计算死亡/治疗失败的累积发生率。
共纳入 55 例患者（83.6%为男性；中位年龄 35 岁；62%为流动劳工；中位随访时间为 1 年）。VL 诊断时的中位 CD4 细胞计数为 66 个/μL（四分位距，38-112）。27 例（49.1%）患者出现 VL 复发。脂质体两性霉素 B 的总体耐受性极好，无治疗中断。VL 治疗后 1 年和 2 年的生存率估计分别为 85.5%。无患者出现初始治疗失败。VL 治疗后 0.5、1 和 2 年的 VL 复发率分别为 0%、8.1%和 26.5%；原发性 VL 和 VL 复发的复发率相似。cART 起始后 6 个月时 CD4 计数＜200 个/μL 预测随后的复发。cART 起始后 6 个月和 24 个月的平均 CD4 细胞计数分别为 187 个/μL 和 261 个/μL。HIV 护理保留率为 83.6%。
接受脂质体两性霉素 B 和 cART 治疗的 VL-HIV 合并感染患者获得了良好的长期生存和保留率。尽管初始 VL 治疗反应良好，但 2 年内 VL 仍频繁复发。
