Visceral leishmaniasis and HIV coinfection: current perspectives

Figures & data

Table 1 Main methods used for the diagnosis of visceral leishmaniasis in patients coinfected with HIV according to sensitivity and specificity

Laboratory method	Brief Description	Sensitivity	Specificity	Comments
Microscopic examination (bone- marrow aspiration)	Microscopic demonstration of amastigote forms	93.2%	100%	Not expensive; invasive method; great specificity and sensitivity
–Giemsa staining
DAT	Agglutination serological test	81%	90%	Better performance of serological methods
rk39 rapid test	Immunochromatographic test using recombinant K39 antigen	46.6–81%	96–100%	Easy and rapid method; great sensitivity and specificity
ELISA	Enzyme immunoassay using total antigens	50–60%	90%	Easy method; variable sensitivity and specificity, depending on antigens; positivity in asymptomatic individuals from endemic area
IFAT	Immunofluorescence to detect antibodies anti-leishmania	51–61%	93%	Easy method; variable sensitivity and specificity, depending on antigens; positivity in asymptomatic individuals from endemic area
PCR	Molecular method using specific targets	87.2–98%	96%	High sensitivity and specificity; not available in all regions; frequently expensive

Abbreviations: DAT, direct agglutination test; IFAT, immunofluorescence antibody test.

Table 2 Main drugs used to treat visceral leishmaniasis in HIV-coinfected patients, according to dose and efficacy

Treatment	Dosage	Efficacy/cure rate**	Reference
Liposomal amphotericin B	6×5 mg/kg/day on alternate days – total dose 30 mg/kg	Parasitological response: 59.5% initial response; 38% effectiveness for visceral leishmaniasis relapses	Ritmeijer et al, 2011^Citation47
Miltefosine	100 mg/day for 28 days	Parastiological response: 64% initial response, with short follow-up (median duration of disease-free interval 4–5 months)	Sindermann et al, 2004^Citation59
Combination therapy
Liposomal amphotericin plus miltefosine	30 mg/kg divided in 6 equal dose on alternate days + 50 mg twice or 50 mg once daily	Eight relapses out 100 patients discharged after intial cure	Mahajan et al, 2015^Citation69

Notes:

* Contraindicated in HIV-infected patients due to toxicities and unacceptable death rate.

** Different criteria to cure definition.

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