Combination Therapy for Visceral Leishmaniasis in Persons Living with HIV

Patients living with HIV are at markedly excess risk for developing visceral leishmaniasis (VL) compared with the general population in endemic regions. The WHO recommends first-line liposomal amphotericin B (AmBisome), but emerging data suggest combining AmBisome with miltefosine offers added clinical benefit. In a small, randomized study, investigators in Bihar, India assigned patients co-infected with HIV and VL to receive AmBisome monotherapy (total dose, 40 mg/kg) or AmBisome (30 mg/kg) with miltefosine. The primary outcome was relapse-free survival at 210 days after starting therapy.

Among 150 enrollees (median age, 38.5), 19% also had tuberculosis. For the combination group compared with monotherapy group at baseline, relapsing VL occ…