Thus, we propose the definition of a clinical entity of ‘active selleck inhibitor chronic visceral leishmaniasis’, which can be observed despite multiple rounds of curative treatment and long-term secondary prophylaxis with amphotericin
B. When visceral leishmaniasis occurs in immunocompetent patients, the immune system contributes to the elimination of the remaining parasites after treatment . A striking characteristic of the HIV-1-infected patients in this study was the failure of immune recovery, despite adequate antiretroviral treatment and good compliance with HAART, resulting in undetectable or very low HIV viral loads. Therefore, immune failure, involving various mechanisms (such as the absence of interleukin-2 and gamma interferon production ), is probably the cause
find more of long-term persistence of Leishmania parasites. Another complementary hypothesis explaining reduced parasite clearance is that parasite ‘sanctuaries’ are present , where anti-leishmanial drugs have limited access and parasites remain sheltered from both the immune system and high amphotericin B concentrations. In summary, this study demonstrates long-term persistence, during asymptomatic periods, of a reduced level of circulating Leishmania parasites that can be detected with sensitive PCR assays. We propose that such a continuous circulation of Leishmania in the blood of HIV-1/Leishmania-coinfected patients presenting alternating asymptomatic and symptomatic visceral leishmaniasis be defined as a clinical
entity termed ‘active chronic visceral leishmaniasis’. The authors thank Dr Christophe Ravel for invaluable help with the PCR application and the staff of the Laboratories of Parasitology of Montpellier and Nîmes for technical Rho assistance. Financial support was obtained from the Centre Hospitalier Universitaire of Montpellier (grant AOI 2005 of the Regional Delegation for Clinical Research to P.B.). “
“The prevalences of the human leucocyte antigen (HLA)-B*5701 and cytochrome P450 2B6 (CYP2B6) 516 polymorphisms were studied concurrently in a cohort of 234 Han Chinese HIV-infected patients. The prevalence of HLA-B*5701 was low at 0.4%, compared with 6% for the CYP2B6 TT genotype. The allelic frequency of 516 GT was 0.24. Our results suggest that screening for the CYP2B6 516 polymorphism in the Chinese population may be useful, whereas screening for HLA-B*5701 may not be, because of its very low prevalence, but this requires further study. Studies are also needed to validate the clinical effectiveness of CYP2B6 screening. Pharmacogenetic testing has become important as a means of optimizing drug treatment in clinical practice.