31
8. See Recs. 61–66 regarding secondary prophylaxis in patients with
HIV/AIDS-associated VL. Chronic maintenance therapy (secondary
prophylaxis) should be given until the CD4 T-lymphocyte cell count
consistently remains >200–350/mm
3
(see Recs. 61–66).
9. See Recs. 51–54 for additional perspective about treatment alternatives.
Parenteral paromomycin appeared promising in clinical trials in India,
but it is not available in North America.
10. Miltefosine has been effective in treating VL in India and adjacent areas
of South Asia where resistance to pentavalent antimonials is prevalent.
There is some evidence to support the use of miltefosine for VL acquired
in East Africa. There is less available evidence to support its use in
southern Europe and Latin America.
11. Resistance to pentavalent antimonials is well documented in India and
has been reported from other areas. In general, pentavalent antimonial
therapy should not be used for persons who acquired VL in India.
12. Personal communication Pierre Buffet, on the basis of expert opinion.
13. Contact information for use in military beneficiaries:
a. Force Health Protection Division's 24-hour cell phone: 301-401-2768
b. Force Health Protection Division's email: usarmy.detrick.medcom-
usammda.mbx.force-health-protection@mail.mil
Footnotes for Tables 3a, 3b & 3c (cont'd)
