[Treatment of visceral leishmaniasis: recent modalities]

AN ENDEMIC DISEASE: Visceral leishmaniasis is an endemic disease in 47 countries and continues to be a difficult therapeutic challenge. The emergence of Leishmania strains resistant to pentavalent antimony derivatives and the growing incidence of visceral leishmaniasis among AIDS patients in the Mediterranean area emphasizes the need for optimal therapeutic management. MORE EFFECTIVE STRATEGIES: During the last few years, alternatives to pentavalent antimony derivatives has disclosed the contribution of amphotericin B, more specifically of lipid formulations of amphotericin B, well tolerated and highly effective drugs [corrected]. Aminosidine, inhibitors of ergosterol synthesis, metronidazole, allupurinol, or miltefosine are also under evaluation. Results have been variable to date. NEW STRATEGIES: It is well demonstrated that the susceptibility of Leishmania to different drugs is species-dependent. Drugs should thus be chosen in accordance with the presumed species in an endemic zone. New strategies based on adapting therapy to the causal species of the parasite, multi-drug regimens, drug vectorization, or restoring immune function in association with secondary prophylaxis in immunodepressed subjects should provide more effective treatment and a lower relapse rate, particularly in patients co-infected with the human immunodeficiency virus.2