Prophylaxis of visceral leishmaniasis in human immunodeficiency virus-infected patients

Objective To assess the effectiveness of two regimens with allopurinol or pentavalent antimony as secondary prophylaxis for visceral leishmaniasis (VL) in human immunodeficiency virus (HIV)-infected patients. design: Retrospective, nonrandomized, open trial. Setting A 1,000-bed academic tertiary institutional hospital in Barcelona. Patients Forty-six individuals over 14 years old with HIV infection, who recovered from an episode of VL between January 1988 and February 1995. Interventions Twenty patients did not receive any prophylaxis, nine received 300 mg/8 h of allopurinol, and 17 received 850 mg once-a-month of pentavalent antimony. Patients were followed-up every 3 months, and the endpoint of study was relapse of VL. Results Twenty-one patients had recurrent VL: 13 of 20 in the control group (65%), 5 of 9 in the allopurinol group (56%), and 3 of 17 in the antimonial group (18%). Kaplan-Meier estimates of the probability of remaining relapse-free at 12 months were 9% without prophylaxis (95% Cl, 0–22%), 21% with allopurinol (95% Cl, 0–51%), and 93% with antimonials (95% Cl, 82–100%) (P< 0.001). Multivariate analysis showed that the only significant variables related to relapsing course of VL were assignment to the antimonial group, and the fact that the patient had experienced a previous episode of VL. Conclusions Pentavalent antimony given once a month is effective in the prevention of VL relapses in HIV-infected individuals. It is a lowcost treatment that proved to be well tolerated. Therefore, pentavalent antimony should be considered a suitable agent for secondary prophylaxis against VL.