Report of a WHO informal consultation on liposomal amphotericin B in the treatment of visceral leishmaniasis

Overview

Liposomal amphotericin B is commonly used to treat visceral leishmaniasis (VL). The World Health Organization (WHO) convened an informal consultation in Rome, Italy, on 16 April 2005 to update the background on and define guidelines for the use of liposomal amphotericin B.

In Europe, this formulation is widely used to treat VL in immunocompetent and immunodepressed patients. The VL disease burden is much higher in Africa and Asia than in Europe, and levels of drug availability are low. Public sector agencies can, however, purchase liposomal amphotericin B for distribution through the public sector of developing countries at a preferential price (in July 2007, US$ 20 per vial of 50 mg). Liposomal amphotericin B (total dose 20 mg/kg) administered in one or two injections has proved to be of high efficacy and low toxicity in immunocompetent VL patients in East Africa, the Mediterranean Basin and Brazil.

Results of some controlled trials indicate that a total dose of 10 to 15 mg/kg in South-East Asia may be sufficient to achieve an equally high cure rate. Recommendations on the use of liposomal amphotericin B, either alone or in combination, have been provided for different forms such as zoonotic and anthroponotic VL as well as for patients infected with human immunodeficiency virus (HIV) and visceral leishmaniasis (HIV-VL coinfection).