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Leprosy — SCE Infectious Diseases MCQ

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HardTropical & Imported InfectionsLeprosySCE Infectious Diseases

A patient with HIV, CD4 42 cells/µL, acquires visceral leishmaniasis in Ethiopia. She is not pregnant and can use reliable contraception. Which WHO regimen is preferred for this regional coinfection?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Liposomal amphotericin B 5 mg/kg on days 1, 3, 5, 7, 9 and 11 plus miltefosine 100 mg/day for 28 days

Explanation lettering: E = shown as B · D = shown as C · C = shown as D · B = shown as E

E is correct. For HIV-associated visceral leishmaniasis in East Africa, WHO conditionally prefers liposomal amphotericin B to a 30-mg/kg total on days 1, 3, 5, 7, 9 and 11 plus miltefosine 100 mg/day for 28 days. A and B abbreviate both the amphotericin and miltefosine exposures. C is the sodium-stibogluconate/paromomycin regimen used in immunocompetent East African visceral leishmaniasis, not preferred HIV coinfection therapy. D combines a 40-mg/kg amphotericin monotherapy schedule with an unvalidated shortened miltefosine course. Pregnancy testing and reliable contraception are mandatory because miltefosine is teratogenic; relapse and secondary prophylaxis require specialist follow-up.

Reference: WHO: visceral leishmaniasis with HIV coinfection: https://www.ncbi.nlm.nih.gov/books/NBK581529/table/fm-ch2.tab1/?report=objectonly