Julia M. Greig

Successful use of miltefosine and sodium stibogluconate, in combination, for the treatment of an HIV-positive patient with visceral leishmaniasis: a case report and brief review of the literature

Visceral leishmaniasis (VL) is particularly difficult to treat in patients who are coinfected with HIV. Whilst liposomal amphotericin (L-AmpB), paromomycin and miltefosine have all been shown to be very successful replacements for the traditional antimony therapy, especially in areas with resistance, their use in those with HIV co-infection has brought disappointingly little additional benefit, even for those on highly active antiretroviral therapy (Laguna, 2003; Ritmeijer et al., 2006). Calls have been made to consider the use of combination antileishmanial therapy — particularly in HIV co-infection — to shorten treatment duration and protect against drug resistance (Berman et al., 2006; Jha, 2006). Here, the successful cure of relapsing VL in a man with HIV co-infection, using a combination of two antileishmanial agents, is reported.

Screening African HIV positive patients for imported parasitic infections

OBJECTIVES To assess the results of screening for tropical parasitic infections in HIV patients from Africa, presenting to an infectious diseases unit in the UK. METHODS A retrospective case note review of patients from Sub-Saharan Africa, newly diagnosed with HIV infection, between March 2001 and November 2007. Data on patient demographics, clinical presentation and laboratory results, including tropical screening tests, were collected. RESULTS 146 patients had notes available for review. 22 different countries were represented. 84 patients were screened, by serology, for schistosomiasis, strongyloidiasis, filariasis and leishmaniasis. 13/122 (10.7%) patients tested had positive schistosomiasis serology and 2/107 (1.9%) had positive strongyloidiasis serology. No patients had positive Leishmania (n = 108) or filaria (n = 97) serology. 3 of 38 (7.9%) had stool samples that were positive for pathogens. Positive schistosomiasis serology was associated with male sex (61.5% vs 28.4% p < 0.05) and a higher mean eosinophil count (0.46 vs 0.12 cells/microL p < 0.0001). CONCLUSION Screening HIV patients from Sub-Saharan Africa for schistosomiasis in this population, was positive in over 1 in 10 patients. We would recommend screening for schistosomiasis in these patients. Our results do not support serological screening for leishmaniasis or filarial infection in these patients.

HIV control in postpartum mothers: a turbulent time.

We conducted an audit looking at the management of HIV-positive women in the postpartum period. We found that of the women with a previous AIDS-defining condition or a CD4 count <350 cells/µL, 83% were correctly continued on antiretroviral therapy (ART) and 84.1% of these had good virological control. ART was correctly stopped in 100% of women who had always had a CD4 count >500 cells/µL. A significant finding from our audit was that all of the women who had poor virological control or stopped ART against medical advice had social issues or self-reported depression. The main recommendation was to extend the pregnancy multidisciplinary team (MDT) meeting to include the 12-month postpartum period to offer support to women to try to improve treatment outcomes.

HIV needs to be excluded

Wood and Peckham discuss the investigation of primary and secondary immunodeficiency in people presenting to primary care with recurrent respiratory tract infections.1 We disagree that HIV is an unlikely underlying cause if there is no history of high risk sex or misuse of intravenous drugs. HIV infection should always be excluded, …