Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents

The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.

Geographic Opportunistic Infections of Specific Consideration

Leishmaniasis

Last Updated: February 6, 2017; Last Reviewed: August 3, 2017

Recommendations for Treating Visceral and Cutaneous Leishmaniasis
Treating Visceral Leishmaniasis
Preferred Therapy:
  • Liposomal amphotericin B 2–4 mg/kg IV daily (AII), or
  • Liposomal amphotericin B interrupted schedule (e.g., 4 mg/kg on days 1–5, 10, 17, 24, 31, 38) (AII)
  • Achieve a total dose of 20–60 mg/kg (AII)
Alternative Therapy:
  • Other amphotericin B lipid complex dosed as above, or
  • Amphotericin B deoxycholate 0.5–1.0 mg/kg IV daily for total dose of 1.5–2.0 grams (BII), or
  • Pentavalent antimony (sodium stibogluconate) 20 mg/kg IV or IM daily for 28 days (BII). (Contact the CDC Drug Service at 404-639-3670 or drugservice@cdc.gov; for emergencies, call 770-488-7100.)
  • Miltefosine (CIII) (available in the United States via www.Profounda.com)
    • For patients who weigh 30–44 kg: 50 mg PO bid for 28 days
    • For patients who weigh ≥45 kg: 50 mg PO tid for 28 days
Chronic Maintenance Therapy for Visceral Leishmaniasis
Indication:
  • For patients with visceral leishmaniasis and CD4 count <200 cells/mm3 (AII)
Preferred Therapy:
  • Liposomal amphotericin B 4 mg/kg every 2–4 weeks (AII), or
  • Amphotericin B Lipid Complex 3 mg/kg every 21 days (AII)
Alternative Therapy:
  • Pentavalent antimony (sodium stibogluconate) 20 mg/kg IV or IM every 4 weeks (BII)
Discontinuation of Chronic Maintenance Therapy
Some investigators suggest that therapy can be discontinued after a sustained (>3 to 6 months) increase in CD4 count to >200 to 350 cells/mm3 in response to ART, but others suggest that therapy should be continued indefinitely. Therefore, no recommendation can be made regarding discontinuation of chronic maintenance therapy.
Treating Cutaneous Leishmaniasis
Preferred Therapy:
  • Liposomal amphotericin B 2–4 mg/kg IV daily for 10 days or interrupted schedule (e.g., 4 mg/kg on days 1–5, 10, 17, 24, 31, 38) to achieve total dose of 20–60 mg/kg (BIII), or
  • Pentavalent antimony (sodium stibogluconate) 20 mg/kg IV or IM daily for 28 days (BIII)
Alternative Therapy:
  • Other options include oral miltefosine (can be obtained in the United States through a treatment IND), topical paromomycin, intralesional pentavalent antimony (sodium stibogluconate), or local heat therapy.
Chronic Maintenance Therapy for Cutaneous Leishmaniasis
  • May be indicated for immunocompromised patients with multiple relapses (CIII)
Key to Acronyms: ART = antiretroviral therapy; CD4 = CD4 T lymphocyte cell; CDC = Centers for Disease Control and Prevention; IM = intramuscular; IND = investigational new drug; IV = intravenous

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