Abstract:

Objective To observe the curative effect and prognosis of prolonged sodium stibogluconate treatment in a case of Leishmania and human immunodeficiency virus(HIV) co-infection. Methods Clinical information of the patient was collected. The curative effect and prognosis were followed-up. Results The patient was working in Jiuzhaigou County of Sichuan Province （an endemic area of visceral leishmaniasis） in 1990. At the end of 1992 he presented with fever, hepatomegaly and splenomegaly, and was diagnosed with liver cirrhosis by local hospitals. The symptoms were not improved after symptomatic treatment, with continued hapastosplenomegaly, accompanied by severe anemia and weight loss. He was later diagnosed with visceral leishmaniasis via bone marrow examination in 1994, and given intravenous infusions of sodium stibogluconate (pentavalent antimony 600 mg/d for 6 days). After 6 days of treatment, his condition got improved. In August 2010, an abdominal mass was found in the left upper quadrant, accompanied by abdominal distension. Leishmania amastigotes were found in the bone marrow smear. Again conventional treatment of pentavalent antimony was given for 6 days and his condition was improved. During hospitalization, the patient was screened for HIV antibody and found positive, which was further confirmed by Western blotting analysis. The CD4⁺ T lymphocytes was as low as 42 cells/ml. He was diagnosed with acquired immunodeficiency syndrome (AIDS). From July 2011, he began to receive conventional treatment including lamivudine (3TC, 300 mg/d) + zidovudine（AZT, 600 mg/d） + efavirenz (EFV, 600 mg/d). Two months later, AZT was replaced by tenofovir (TDF, 300 mg/d) due to severe anemia. On 25 July 2012, he was admitted to our hospital for “abdominal distension for two years”. Physical examination showed severe pallor and hepatosplenomegaly (the liver was 2 cm below the costal edge and the spleen was palpable 7 cm below the umbilical level). Leishmania was found in the bone marrow aspirate. Therefore, anti-HIV treatment with 3TC + TDF + EFV was continued, combined with sodium stibogluconate (pentavalent antimony 600 mg/day for 4 days, and 1 200 mg/day for an additional 4 days). After the liver and spleen began to shrink, the usage of stibogluconate therapy (pentavalent antimony 600 mg per time for 22 times) was changed every other day. Another two phase treatment with stibogluconate (pentavalent antimony 600 mg for 18 times) was given at one month and three months after the end of first phase treatment, respectively. The patient was given pentavalent antimony therapy with a total dose of up to 42 g during the three phase treatment, while also receiving conventional treatment on AIDS. Fifty months after pentavalent antimony withdrawal in April 2017, Leishmania was not found in the bone marrow, the CD4⁺ T lymphocytes was 225 cells/ml, and HIV-RNA was below detection limit. Conclusion Prolonged stibogluconate and conventional treatment can cure visceral leishmaniasis co-infected with HIV.

Key words: Visceral leishmaniasis, Human immunodeficiency virus, Co-infection, Sodium stibogluconate, Treatment, Follow-up