allopurinol and AIDS-Related-Opportunistic-Infections

To analyze the clinical features, yield of the diagnostic techniques, and therapeutic response of HIV-associated visceral leishmaniasis (VL), and compare the initial episodes to the relapses.. Forty-one episodes of leishmaniasis visceral, diagnosed in 31 HIV-positive patients between 1st February 1992 and 31st January 1996 were reviewed.. The prevalence of VL in HIV-positive patients in our center was 4.2%. Fifty-eight percent of the patients had AIDS prior to the diagnosis of VL. Fever was more frequent in the initial episodes than in the relapses (90.3% versus 60%; p < 0.05; OR: 6.2; IC 95%: 0.8-51.5), splenomegaly was more frequent in the relapses (100% versus 71%; p = 0.05). The diagnostic delay was longer in the initial episodes (27.2 +/- 22.7 versus 5 +/- 4.8 days; p < 0.05). The diagnostic yield of bone marrow biopsy was 82.1%, of liver biopsy 72.7% and of splenic fine-needle aspiration 87.5%. The indirect immunofluorescence test for Leishmania antibodies was positive in 5.9% of cases. Therapeutic failure occurred in 47.6% of patients treated with antimonials and 3.3% of patients treated with amphotericin B. Those patients who received secondary prophylaxis had less relapses than those who did not (17.6% versus 66.7%; p < 0.05; OR: 0.11; IC 95%: 0.01-1.28). Of the 31 patients, twenty-six (83.8%) died, and in none of them was the cause of the death directly related to LV.. HIV-associated VL manifests clinically in a similar fashion to the immunocompetent's disease. It appears in advanced immunosuppression phases, behaving like other AIDS-defining illnesses. In spite of a good therapeutic response the relapse rate is high.

Topics: Adult; AIDS-Related Opportunistic Infections; Allopurinol; Amphotericin B; Antiprotozoal Agents; Drug Therapy, Combination; Female; HIV-1; Humans; Leishmaniasis, Visceral; Male; Prevalence; Recurrence; Spain

The experience with 52 episodes of visceral leishmaniasis diagnosed in 43 patients is reported. The most common symptoms were fever (81%), splenomegaly (65%), hepatomegaly (63%), and pancytopenia (73%). In 79% of the patients, CD4+ cell counts were < 100 cells/mm3. Prior or simultaneous diagnosis of AIDS was made in 29 (67%) patients. Diagnosis was considered fortuitous in 19% of the episodes. In 27% of the episodes, the diagnosis was made on the basis of demonstration of parasites outside the reticuloendothelial system, chiefly blood (7 cases) and gastrointestinal mucosa (5 cases). Parasites were frequently observed or cultured from blood (22/37 episodes) or the digestive tract (8/9 episodes). High antimony doses were more effective than low doses in achieving clinical or parasitological cure (rate of cure, 80% vs. 40%, p = 0.11). Severe toxicity was observed in six (11.7%) of the 51 treated episodes. Severe AIDS-related diseases [odds ratio (OR) 10, p < 0.05] and CD4+ counts (OR 12, p < 0.05) were independent factors for early death. Prophylaxis with monthly pentamidine was not useful in reducing relapses of visceral leishmaniasis.

Topics: AIDS-Related Opportunistic Infections; Allopurinol; Amebicides; Amphotericin B; Analysis of Variance; Anti-HIV Agents; Antimetabolites; Antimony; Antiprotozoal Agents; Blood; Bone Marrow; CD4-Positive T-Lymphocytes; Cerebrospinal Fluid; Didanosine; Digestive System; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Follow-Up Studies; Hepatic Encephalopathy; HIV; Humans; Intestinal Mucosa; Leishmaniasis, Visceral; Lymphocyte Count; Male; Myocarditis; Neutrophils; Pancreatitis; Pentamidine; Renal Insufficiency; Spain; Zidovudine

Topics: Adult; AIDS-Related Opportunistic Infections; Allopurinol; Animals; Anti-Infective Agents; Antimetabolites; Humans; Itraconazole; Leishmania; Leishmaniasis, Visceral; Male

We report on 11 patients with HIV infection and visceral leishmaniasis and who were treated with meglumine antimoniate plus allopurinol for 3 weeks (six patients) or 4 weeks (five patients). Clinical and parasitological cures were achieved in four of the five patients treated for 4 weeks and in one of the six patients treated for 3 weeks. Only one patient developed a severe maculopapular rash. Allopurinol plus meglumine antimoniate was found to be a safe combination of drugs for the treatment of visceral leishmaniasis in patients infected with HIV. The optimal length of this treatment is unknown but a course of at least 4 weeks' duration would appear to be necessary for obtaining parasitological cure in most cases.

Topics: Acquired Immunodeficiency Syndrome; Administration, Oral; Adult; AIDS-Related Opportunistic Infections; Allopurinol; Antiprotozoal Agents; Drug Therapy, Combination; Female; HIV Infections; Humans; Injections, Intramuscular; Leishmaniasis, Visceral; Male; Meglumine; Meglumine Antimoniate; Organometallic Compounds; Pilot Projects

To investigate the epidemiological, clinical and biological features of visceral leishmaniasis (VL) in patients with HIV-1 infection.. Retrospective study.. Three university hospitals in southern Spain.. Forty-seven adult patients with VL and HIV-1 infection diagnosed between January 1986 and November 1991.. Forty-five out of the 47 (96%) cases were diagnosed in the last 2 years. Fever (87%), hepatomegaly (74%), splenomegaly (72%) and pancytopenia (77%) were the most common presenting features. Most patients (79%) were strongly immunocompromised when VL was diagnosed, and were in stage IV of the Centers for Disease Control classification; 87% had a CD4 lymphocyte count < 200 x 10(6)/l. However, VL was the first severe infection diagnosed in 10 cases. Significant titres (> 1:40) of antileishmanial antibodies were detected by indirect immunofluorescence in five out of 16 (31%) cases only. Clinical response to the therapy was difficult to assess. Microbiological response was achieved in only 38% of the patients evaluated.. Leishmaniasis is a relatively common infection in HIV-1-infected individuals in southern Spain. Its clinical picture is quite uniform and it can be the first opportunistic infection in individuals with HIV-1. In endemic areas, a high index of clinical suspicion should be maintained in order to avoid underdiagnosis of leishmaniasis.. Physicians examined the records of 47 adults with visceral leishmaniasis (VL) and HIV-1 infection who were patients at 3 urban teaching hospitals in the Andalucia region in southern Spain between January 1986 and November 1991. They wanted to identify the clinical, biological, and epidemiological features of VL in HIV-1 positive patients. 96% of the cases were diagnosed with both infections during the last 2 years of the study period and 79% between January and November 1991. All the patients had risk factors for HIV infection (65.9% IV drug use, 21.3% sexual contact, and 12.8% blood transfusion). 70% exhibited the classic symptoms of VL (fever, enlarged liver and spleen, and depressed counts of blood cells). Most patients were already very immunocompromised when VL was diagnosed. 87% had a total lymphocyte count of less than 1000 x 1 million/1 and a CD4 lymphocyte count of less than 200 x 1 million/1. In fact, 66% had full blown AIDS prior to diagnosis of VL. VL was the first severe infection in 10 cases. 68% also suffered from opportunistic infections, especially candidiasis, extrapulmonary tuberculosis, and Pneumocystis carinii pneumonia. Microscopic examination of Leishmania amastiogotes in tissue samples led to a diagnosis in 94% of cases, isolation of motile amastigotes in culture of bone marrow aspirate in 2%, and microscopic and culture in 4%. Just 46% completed a full course of treatment (pentavalent antimony, allopurinol, and/or pentamidine). Only 38% had a microbiological response. Immunofluorescence detected sizeable titers (1:40) of antileishmanial antibodies in just 31% of cases. 17% experienced clear clinical improvement. Physicians in endemic areas should consider VL in every HIV-1 infected patient with fever, hepatosplenomegaly, or hematological abnormalities to avoid underdiagnosis of leishmaniasis.

Topics: Adult; AIDS-Related Opportunistic Infections; Allopurinol; Antiprotozoal Agents; CD4-Positive T-Lymphocytes; Female; HIV-1; Hospitals, University; Humans; Leishmaniasis, Visceral; Leukocyte Count; Male; Meglumine; Meglumine Antimoniate; Organometallic Compounds; Pentamidine; Retrospective Studies; Spain; Treatment Outcome