Use of Pentamidine As Secondary Prophylaxis to Prevent Visceral Leishmaniasis Relapse in HIV Infected Patients, the First Twelve Months of a Prospective Cohort Study.
BACKGROUND: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 assessed the effectiveness, safety and feasibility of month...
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ftdoajarticles:oai:doaj.org/article:8280c0c1aa344d8b990b84a5db3fa6f4 2023-05-15T15:12:29+02:00 Use of Pentamidine As Secondary Prophylaxis to Prevent Visceral Leishmaniasis Relapse in HIV Infected Patients, the First Twelve Months of a Prospective Cohort Study. Ermias Diro Koert Ritmeijer Marleen Boelaert Fabiana Alves Rezika Mohammed Charles Abongomera Raffaella Ravinetto Maaike De Crop Helina Fikre Cherinet Adera Robert Colebunders Harry van Loen Joris Menten Lutgarde Lynen Asrat Hailu Johan van Griensven 2015-01-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0004087 https://doaj.org/article/8280c0c1aa344d8b990b84a5db3fa6f4 EN eng Public Library of Science (PLoS) http://europepmc.org/articles/PMC4591988?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0004087 https://doaj.org/article/8280c0c1aa344d8b990b84a5db3fa6f4 PLoS Neglected Tropical Diseases, Vol 9, Iss 10, p e0004087 (2015) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2015 ftdoajarticles https://doi.org/10.1371/journal.pntd.0004087 2022-12-31T00:34:42Z BACKGROUND: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 assessed the effectiveness, safety and feasibility of monthly pentamidine infusions to prevent recurrence of VL in HIV co-infected patients. METHODS:A single-arm, open-label trial was conducted at two leishmaniasis treatment centers in northwest Ethiopia. HIV-infected patients with a VL episode were included after parasitological cure. Monthly infusions of 4 mg/kg pentamidine-isethionate diluted in normal-saline were started for 12 months. All received antiretroviral therapy (ART). Time-to-relapse or death was the primary end point. RESULTS:Seventy-four patients were included. The probability of relapse-free survival at 6 months and at 12 months was 79% and 71% respectively. Renal failure, a possible drug-related serious adverse event, occurred in two patients with severe pneumonia. Forty-one patients completed the regimen taking at least 11 of the 12 doses. Main reasons to discontinue were: 15 relapsed, five died and seven became lost to follow-up. More patients failed among those with a CD4+cell count ≤ 50 cells/μl, 5/7 (71.4%) than those with counts above 200 cells/μl, 2/12 (16.7%), (p = 0.005). CONCLUSION: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. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 9 10 e0004087 |
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Open Polar |
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Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Ermias Diro Koert Ritmeijer Marleen Boelaert Fabiana Alves Rezika Mohammed Charles Abongomera Raffaella Ravinetto Maaike De Crop Helina Fikre Cherinet Adera Robert Colebunders Harry van Loen Joris Menten Lutgarde Lynen Asrat Hailu Johan van Griensven Use of Pentamidine As Secondary Prophylaxis to Prevent Visceral Leishmaniasis Relapse in HIV Infected Patients, the First Twelve Months of a Prospective Cohort Study. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
BACKGROUND: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 assessed the effectiveness, safety and feasibility of monthly pentamidine infusions to prevent recurrence of VL in HIV co-infected patients. METHODS:A single-arm, open-label trial was conducted at two leishmaniasis treatment centers in northwest Ethiopia. HIV-infected patients with a VL episode were included after parasitological cure. Monthly infusions of 4 mg/kg pentamidine-isethionate diluted in normal-saline were started for 12 months. All received antiretroviral therapy (ART). Time-to-relapse or death was the primary end point. RESULTS:Seventy-four patients were included. The probability of relapse-free survival at 6 months and at 12 months was 79% and 71% respectively. Renal failure, a possible drug-related serious adverse event, occurred in two patients with severe pneumonia. Forty-one patients completed the regimen taking at least 11 of the 12 doses. Main reasons to discontinue were: 15 relapsed, five died and seven became lost to follow-up. More patients failed among those with a CD4+cell count ≤ 50 cells/μl, 5/7 (71.4%) than those with counts above 200 cells/μl, 2/12 (16.7%), (p = 0.005). CONCLUSION: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. |
format |
Article in Journal/Newspaper |
author |
Ermias Diro Koert Ritmeijer Marleen Boelaert Fabiana Alves Rezika Mohammed Charles Abongomera Raffaella Ravinetto Maaike De Crop Helina Fikre Cherinet Adera Robert Colebunders Harry van Loen Joris Menten Lutgarde Lynen Asrat Hailu Johan van Griensven |
author_facet |
Ermias Diro Koert Ritmeijer Marleen Boelaert Fabiana Alves Rezika Mohammed Charles Abongomera Raffaella Ravinetto Maaike De Crop Helina Fikre Cherinet Adera Robert Colebunders Harry van Loen Joris Menten Lutgarde Lynen Asrat Hailu Johan van Griensven |
author_sort |
Ermias Diro |
title |
Use of Pentamidine As Secondary Prophylaxis to Prevent Visceral Leishmaniasis Relapse in HIV Infected Patients, the First Twelve Months of a Prospective Cohort Study. |
title_short |
Use of Pentamidine As Secondary Prophylaxis to Prevent Visceral Leishmaniasis Relapse in HIV Infected Patients, the First Twelve Months of a Prospective Cohort Study. |
title_full |
Use of Pentamidine As Secondary Prophylaxis to Prevent Visceral Leishmaniasis Relapse in HIV Infected Patients, the First Twelve Months of a Prospective Cohort Study. |
title_fullStr |
Use of Pentamidine As Secondary Prophylaxis to Prevent Visceral Leishmaniasis Relapse in HIV Infected Patients, the First Twelve Months of a Prospective Cohort Study. |
title_full_unstemmed |
Use of Pentamidine As Secondary Prophylaxis to Prevent Visceral Leishmaniasis Relapse in HIV Infected Patients, the First Twelve Months of a Prospective Cohort Study. |
title_sort |
use of pentamidine as secondary prophylaxis to prevent visceral leishmaniasis relapse in hiv infected patients, the first twelve months of a prospective cohort study. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2015 |
url |
https://doi.org/10.1371/journal.pntd.0004087 https://doaj.org/article/8280c0c1aa344d8b990b84a5db3fa6f4 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 9, Iss 10, p e0004087 (2015) |
op_relation |
http://europepmc.org/articles/PMC4591988?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0004087 https://doaj.org/article/8280c0c1aa344d8b990b84a5db3fa6f4 |
op_doi |
https://doi.org/10.1371/journal.pntd.0004087 |
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PLOS Neglected Tropical Diseases |
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9 |
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10 |
container_start_page |
e0004087 |
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