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Case Report: No Response to Liposomal Daunorubicin in a Patient with Drug-Resistant HIV-Associated Visceral Leishmaniasis.

Gow NJ, Davidson RN, Ticehurst R, Burns A, Thomas MG - PLoS Negl Trop Dis (2015)

Bottom Line: Visceral leishmaniasis (VL) in patients with HIV co-infection presents a significant therapeutic challenge due to the lessened chance of achieving long-term cure.To our knowledge, he was the first patient with VL and HIV co-infection to have this treatment evaluated.We report on the lack of response to this treatment and possible causes for its failure.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases, Auckland City Hospital, Auckland, New Zealand.

ABSTRACT
Visceral leishmaniasis (VL) in patients with HIV co-infection presents a significant therapeutic challenge due to the lessened chance of achieving long-term cure. We report a case of VL in a 60-year-old man with HIV infection who became refractory to anti-leishmania treatment due to multi-drug resistance. In the face of a worsening clinical situation, and with no other options available, he was treated with an experimental regimen of liposomal daunorubicin, which has previously been shown to have in vitro activity against Leishmania donovani and to be effective treatment of VL in animal studies. To our knowledge, he was the first patient with VL and HIV co-infection to have this treatment evaluated. We report on the lack of response to this treatment and possible causes for its failure.

No MeSH data available.


Related in: MedlinePlus

(A) Trend of CD4 count, haemoglobin, platelet count and absolute neutrophil count, prior to treatment with liposomal daunorubicin 1993–2012.(B) Trend of CD4 count, haemoglobin, platelet count and absolute neutrophil count, September 2012-August 2013.
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pntd.0003983.g001: (A) Trend of CD4 count, haemoglobin, platelet count and absolute neutrophil count, prior to treatment with liposomal daunorubicin 1993–2012.(B) Trend of CD4 count, haemoglobin, platelet count and absolute neutrophil count, September 2012-August 2013.

Mentions: The patient was a 60 year old European homosexual man who had HIV infection diagnosed in 1985. Zidovudine monotherapy was commenced in 1988 and three-drug combination antiretroviral therapy (ART) in 1996. His ART between 2001 and 2013 consisted of lopinavir/ritonavir, lamivudine and nevirapine. He had a prompt sustained response to ART and from 1997–2013 consistently had an undetectable HIV viral load. Despite this, his CD4 count, which had a nadir of 39 in 1996, never rose above 140 despite consistent adherence to his ART (Fig 1A).


Case Report: No Response to Liposomal Daunorubicin in a Patient with Drug-Resistant HIV-Associated Visceral Leishmaniasis.

Gow NJ, Davidson RN, Ticehurst R, Burns A, Thomas MG - PLoS Negl Trop Dis (2015)

(A) Trend of CD4 count, haemoglobin, platelet count and absolute neutrophil count, prior to treatment with liposomal daunorubicin 1993–2012.(B) Trend of CD4 count, haemoglobin, platelet count and absolute neutrophil count, September 2012-August 2013.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4549335&req=5

pntd.0003983.g001: (A) Trend of CD4 count, haemoglobin, platelet count and absolute neutrophil count, prior to treatment with liposomal daunorubicin 1993–2012.(B) Trend of CD4 count, haemoglobin, platelet count and absolute neutrophil count, September 2012-August 2013.
Mentions: The patient was a 60 year old European homosexual man who had HIV infection diagnosed in 1985. Zidovudine monotherapy was commenced in 1988 and three-drug combination antiretroviral therapy (ART) in 1996. His ART between 2001 and 2013 consisted of lopinavir/ritonavir, lamivudine and nevirapine. He had a prompt sustained response to ART and from 1997–2013 consistently had an undetectable HIV viral load. Despite this, his CD4 count, which had a nadir of 39 in 1996, never rose above 140 despite consistent adherence to his ART (Fig 1A).

Bottom Line: Visceral leishmaniasis (VL) in patients with HIV co-infection presents a significant therapeutic challenge due to the lessened chance of achieving long-term cure.To our knowledge, he was the first patient with VL and HIV co-infection to have this treatment evaluated.We report on the lack of response to this treatment and possible causes for its failure.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases, Auckland City Hospital, Auckland, New Zealand.

ABSTRACT
Visceral leishmaniasis (VL) in patients with HIV co-infection presents a significant therapeutic challenge due to the lessened chance of achieving long-term cure. We report a case of VL in a 60-year-old man with HIV infection who became refractory to anti-leishmania treatment due to multi-drug resistance. In the face of a worsening clinical situation, and with no other options available, he was treated with an experimental regimen of liposomal daunorubicin, which has previously been shown to have in vitro activity against Leishmania donovani and to be effective treatment of VL in animal studies. To our knowledge, he was the first patient with VL and HIV co-infection to have this treatment evaluated. We report on the lack of response to this treatment and possible causes for its failure.

No MeSH data available.


Related in: MedlinePlus