Leishmaniasis (visceral leishmaniasis)

Diagnosis and treatment

Diagnosis:
microscopy or PCR in smears, body fluids or tissue

Notes on treatment:
see also Anti-infective/ART interaction table for treatment optimization

	Drug / Dose	Comments
Preferred treatment	liposomal amphotericin B 2-4 mg/kg qd iv for 10 consecutive days	Then secondary prophylaxis
OR liposomal amphotericin B 4 mg/kg qd iv on day 1-5, 10, 17, 24, 31 and 38
Alternative therapy	lipid complex amphotericin B 3 mg/kg qd iv	10 days
OR amphotericin B deoxycholate 0.5-1 mg/kg qd iv (total dose 1.5-2 g)
OR liposomal amphotericin B 5 mg/kg every other day (days 1, 3, 5, 7, 9, 11) + Miltefosine 50 mg bid for 14 days	The efficacy of this regimen has not been assessed in regions where L. infantum is prevalent (i.e. Europe, Mediterranean basin)
OR pentavalent antimonium salt (Glucantime^®) 20 mg/kg qd iv or im	4 weeks
OR miltefosine 1.5-2.5 mg/kg qd po	4 weeks Efficacy of miltefosine can vary in different Leishmania spp. and has been reported to be lower in L. infantum

Drug / Dose

Comments

Preferred treatment

liposomal amphotericin B
2-4 mg/kg qd iv for 10 consecutive days

Then secondary prophylaxis

OR
liposomal amphotericin B
4 mg/kg qd iv on day 1-5, 10, 17, 24, 31 and 38

Alternative therapy

lipid complex amphotericin B
3 mg/kg qd iv

10 days

OR
amphotericin B deoxycholate
0.5-1 mg/kg qd iv (total dose 1.5-2 g)

OR
liposomal amphotericin B
5 mg/kg every other day (days 1, 3, 5, 7, 9, 11)
+ Miltefosine
50 mg bid for 14 days

The efficacy of this regimen has not been assessed in regions where L. infantum is prevalent (i.e. Europe, Mediterranean basin)

OR
pentavalent antimonium salt (Glucantime^®)
20 mg/kg qd iv or im

4 weeks

OR
miltefosine
1.5-2.5 mg/kg qd po

4 weeks
Efficacy of miltefosine can vary in different Leishmania spp. and has been reported to be lower in L. infantum

Secondary Prophylaxis / Maintenance Therapy

Consider stopping: if CD4 count > 200-350 cells/μL and HIV-VL undetectable over 3 months, no relapse for at least 6 months and negative PCR in blood or negative urinary antigen

	Drug / Dose
Preferred treatment	liposomal amphotericin B 4 mg/kg every 2-4 weeks iv
OR lipid complex amphotericin B 3 mg/kg every 3 weeks iv
Alternative therapy	pentavalent antimonium salts (Glucantime^®) 20 mg/kg every 4 weeks iv/im
OR miltefosine 100 mg qd po
OR pentamidine 300 mg every 3 to 4 weeks iv

Drug / Dose

Preferred treatment

liposomal amphotericin B
4 mg/kg every 2-4 weeks iv

OR
lipid complex amphotericin B
3 mg/kg every 3 weeks iv

Alternative therapy

pentavalent antimonium salts (Glucantime^®)
20 mg/kg every 4 weeks iv/im

OR
miltefosine
100 mg qd po

OR
pentamidine
300 mg every 3 to 4 weeks iv