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VL-HIV co-infection — DTM&H MCQ

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HardProtozoal InfectionsVL-HIV co-infectionDTM&H

An Ethiopian man with HIV and treated visceral leishmaniasis has CD4 85 cells/µL despite starting ART. Which secondary-prophylaxis strategy is specifically recommended for high-relapse-risk patients in East Africa?

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Correct answer: A — Pentamidine isethionate 4 mg/kg every 3–4 weeks with ART optimisation

The best answer is “Pentamidine isethionate 4 mg/kg every 3–4 weeks with ART optimisation”. WHO conditionally recommends secondary prophylaxis after a first VL episode in HIV co-infection in East Africa, particularly with CD4 below 200. The region-specific regimen is pentamidine isethionate every 3–4 weeks; low-dose amphotericin regimens are the corresponding South-East Asian approach.

Reference: WHO 2022 guideline: visceral leishmaniasis in HIV co-infection: https://www.ncbi.nlm.nih.gov/books/NBK581529/table/fm-ch2.tab2/