Liposomal amphotericin B and rHuGM-CSF for treatment of visceral leishmaniasis in AIDS.

In recent years, several reports have emphasized the increasing importance of visceral leishmaniasis as an opportunistic infection among HIV-positive patients in areas where both infections are endemic. Major challenges in the treatment of leishmaniasis include widespread resistance to pentavalent antimonial compounds, absence of safe chemotherapeutic agents, and treatment failure and relapses in HIV-leishmania coinfected patients. Despite the associated adverse reactions and the need for prolonged parenteral treatment, for several decades pentavalent antimony has remained the traditional, first-line therapy for kala-azar throughout the world. However conventional antimony treatment for visceral leishmaniasis has several main drawbacks, including the toxicity of pentavalent antimonials, the prolonged therapy required to achieve cure, and the risk of relapse even after initial good response. In recent years, the search for alternative treatment has led to the recognition of lipid associated amphotericin B formulations as powerful antileishmanial agents. Several observations have also suggested that GM-CSF can be used as an antileishmanial treatment. Indeed, GM-CSF induces potentially beneficial effects in visceral leishmaniasis, such as blood monocyte mobilization, macrophage activation, and amelioration of granulocytopenia. In this report, we describe the safety and efficacy of combination treatment with liposomal amphotericin B and rHuGM-CSF immunotherapy used for the therapy of visceral leishmaniasis in a patient with AIDS.