The American journal of medicine · 1996
Prophylaxis of visceral leishmaniasis in human immunodeficiency virus-infected patients.
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Ribera E, Ocaña I, de Otero J, Cortes E, Gasser I, Pahissa A
Аннотация
OBJECTIVE: To assess the effectiveness of two regimens with allopurinol or pentavalent antimony as secondary prophylaxis for visceral leishmaniasis (VL) in human immunodeficiency virus (HIV)-infected patients.
DESIGN: Retrospective, nonrandomized, open trial.
SETTING: A 1,000-bed academic tertiary institutional hospital in Barcelona.
PATIENTS: Forty-six individuals over 14 years old with HIV infection, who recovered from an episode of VL between January 1988 and February 1995.
INTERVENTIONS: Twenty patients did not receive any prophylaxis, nine received 300 mg/8 h of allopurinol, and 17 received 850 mg once-a-month of pentavalent antimony. Patients were followed-up every 3 months, and the endpoint of study was relapse of VL.
RESULTS: Twenty-one patients had recurrent VL: 13 of 20 in the control group (65%), 5 of 9 in the allopurinol group (56%), and 3 of 17 in the antimonial group (18%). Kaplan-Meier estimates of the probability of remaining relapse-free at 12 months were 9% without prophylaxis (95% CI, 0-22%), 21% with allopurinol (95% CI, 0-51%), and 93% with antimonials (95% CI, 82-100%) (P < 0.001). Multivariate analysis showed that the only significant variables related to relapsing course of VL were assignment to the antimonial group, and the fact that the patient had experienced a previous episode of VL.
CONCLUSIONS: Pentavalent antimony given once a month is effective in the prevention of VL relapses in HIV-infected individuals. It is a low-cost treatment that proved to be well tolerated. Therefore, pentavalent antimony should be considered a suitable agent for secondary prophylaxis against VL.
DESIGN: Retrospective, nonrandomized, open trial.
SETTING: A 1,000-bed academic tertiary institutional hospital in Barcelona.
PATIENTS: Forty-six individuals over 14 years old with HIV infection, who recovered from an episode of VL between January 1988 and February 1995.
INTERVENTIONS: Twenty patients did not receive any prophylaxis, nine received 300 mg/8 h of allopurinol, and 17 received 850 mg once-a-month of pentavalent antimony. Patients were followed-up every 3 months, and the endpoint of study was relapse of VL.
RESULTS: Twenty-one patients had recurrent VL: 13 of 20 in the control group (65%), 5 of 9 in the allopurinol group (56%), and 3 of 17 in the antimonial group (18%). Kaplan-Meier estimates of the probability of remaining relapse-free at 12 months were 9% without prophylaxis (95% CI, 0-22%), 21% with allopurinol (95% CI, 0-51%), and 93% with antimonials (95% CI, 82-100%) (P < 0.001). Multivariate analysis showed that the only significant variables related to relapsing course of VL were assignment to the antimonial group, and the fact that the patient had experienced a previous episode of VL.
CONCLUSIONS: Pentavalent antimony given once a month is effective in the prevention of VL relapses in HIV-infected individuals. It is a low-cost treatment that proved to be well tolerated. Therefore, pentavalent antimony should be considered a suitable agent for secondary prophylaxis against VL.
Предметные рубрики MeSH
AdultAgedAllopurinolAnimalsAntimonyAntimony Sodium GluconateAntiprotozoal AgentsData Interpretation, StatisticalFemaleFollow-Up StudiesHIV InfectionsHumansLeishmaniasis, VisceralMaleMeglumineMeglumine AntimoniateMiddle AgedMultivariate AnalysisOrganometallic CompoundsRecurrenceRetrospective StudiesTime Factors