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Visceral leishmaniasis and HIV co-infection in Bihar, India: long-term effectiveness and treatment outcomes with liposomal amphotericin B (AmBisome)

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dc.contributor.author Burza, S. en_US
dc.contributor.author Mahajan, R. en_US
dc.contributor.author Sinha, P. K. en_US
dc.contributor.author van Griensven, J. en_US
dc.contributor.author Pandey, K. en_US
dc.contributor.author Lima, M. A. en_US
dc.contributor.author Sanz, M. G. en_US
dc.contributor.author Sunyoto, T. en_US
dc.contributor.author Kumar, S. en_US
dc.contributor.author Mitra, G. en_US
dc.contributor.author Kumar, R. en_US
dc.contributor.author Verma, N. en_US
dc.contributor.author Das, P. en_US
dc.date.accessioned 2014-09-25T13:39:43Z
dc.date.available 2014-09-25T13:39:43Z
dc.date.issued 2014 en_US
dc.identifier.issn 1935-2727 en_US
dc.identifier.doi http://dx.doi.org/10.1371/journal.pntd.0003053 en_US
dc.identifier.other ITG-C1B; ITG-C4A; ITG-C5A; ITG-C12B; ITG-CLB; DCS; U-INFDIS; JIF; DOI; FTA; E-only; OAJ; Abstract; UPD56 en_US
dc.identifier.uri http://hdl.handle.net/10390/7828
dc.description.abstract BACKGROUND: Visceral Leishmaniasis (VL; also known as kala-azar) is an ultimately fatal disease endemic in the Indian state of Bihar, while HIV/AIDS is an emerging disease in this region. A 2011 observational cohort study conducted in Bihar involving 55 VL/HIV co-infected patients treated with 20-25 mg/kg intravenous liposomal amphotericin B (AmBisome) estimated an 85.5% probability of survival and a 26.5% probability of VL relapse within 2 years. Here we report the long-term field outcomes of a larger cohort of co-infected patients treated with this regimen between 2007 and 2012. METHODS AND PRINCIPAL FINDINGS: Intravenous AmBisome (20-25 mg/kg) was administered to 159 VL/HIV co-infected patients (both primary infections and relapses) in four or five doses of 5 mg/kg over 4-10 days. Initial cure of VL at discharge was defined as improved symptoms, cessation of fever, improvement of appetite and recession of spleen enlargement. Test of cure was not routinely performed. Antiretroviral treatment (ART) was initiated in 23 (14.5%), 39 (24.5%) and 61 (38.4%) before, during and after admission respectively. Initial cure was achieved in all discharged patients. A total of 36 patients died during follow-up, including six who died shortly after admission. Death occurred at a median of 11 weeks (IQR 4-51) after starting VL treatment. Estimated mortality risk was 14.3% at six months, 22.4% at two years and 29.7% at four years after treatment. Among the 153 patients discharged from the hospital, 26 cases of VL relapse were diagnosed during follow-up, occurring at a median of 10 months (IQR 7-14) after discharge. After accounting for competing risks, the estimated risk of relapse was 16.1% at one year, 20.4% at two years and 25.9% at four years. Low hemoglobin level and concurrent infection with tuberculosis were independent risk factors for mortality, while ART initiated shortly after admission for VL treatment was associated with a 64-66% reduced risk of mortality and 75% reduced risk of relapse. SIGNIFICANCE: This is the largest cohort of HIV-VL co-infected patients reported from the Indian subcontinent. Even after initial cure following treatment with AmBisome, these patients appear to have much higher rates of VL relapse and mortality than patients not known to be HIV-positive, although relapse rates appear to stabilize after 2 years. These results extend the earlier findings that co-infected patients are at increased risk of death and require a multidisciplinary approach for long-term management. en_US
dc.language English en_US
dc.subject Protozoal diseases en_US
dc.subject Kala azar en_US
dc.subject Visceral en_US
dc.subject Leishmaniasis en_US
dc.subject Leishmania donovani en_US
dc.subject Co-infections en_US
dc.subject Viral diseases en_US
dc.subject HIV en_US
dc.subject AIDS en_US
dc.subject Clinical management en_US
dc.subject Treatment en_US
dc.subject Effectiveness en_US
dc.subject Long term en_US
dc.subject Liposomal amphotericin B en_US
dc.subject Relapses en_US
dc.subject Mortality en_US
dc.subject Risk en_US
dc.subject India en_US
dc.subject Asia, South en_US
dc.title Visceral leishmaniasis and HIV co-infection in Bihar, India: long-term effectiveness and treatment outcomes with liposomal amphotericin B (AmBisome) en_US
dc.type Article-E en_US
dc.citation.issue 8 en_US
dc.citation.jtitle PLoS Neglected Tropical Diseases en_US
dc.citation.volume 8 en_US
dc.citation.pages e3053 en_US
dc.identifier.pmid http://www.ncbi.nlm.nih.gov/pubmed/25101665 en_US
dc.citation.jabbreviation PLoS Negl Trop Dis en_US


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