Table 1. Overview of current evidence related to different aspects of VL–HIV care in East Africa.

Objective	Status: Experience in Northwestern Ethiopia
Achieving parasitological cure	Antimonials: toxicity, suboptimal efficacy [10] Miltefosine: safe but limited efficacy [11] AmBisome 30 mg/kg: safe but limited efficacy [12] • Initial treatment cure rate of 74% in primary VL and 38% in relapsed VL; overall cure rate 59% AmBisome 30 mg/kg IV + miltefosine PO for 28 days in compassionate use [6] • Initial cure rate of 81%
Early ART initiation	Retrospective patient file review in one referral and one district hospital in Northwestern Ethiopia. Amongst newly diagnosed VL–HIV patients, ART uptake was 28% (13/47) at the district hospital and 61% (30/49) at the referral hospital [13]
Preventing VL relapse (secondary prophylaxis)	Single-arm clinical trial evaluating monthly administration of pentamidine 4 mg/kg IV for a minimum of 12 months; a 6-month extension was given for those with CD4 counts ≤ 200 cells/μL by 12 months of pentamidine [6, 14]. No relapse after pentamidine discontinuation if CD4 counts > 200 cells/μL by 12 months of pentamidine (0/28) 3 out of 17 relapses in those with CD4 counts ≤ 200 cells/μL by 12 months, despite a 6-month pentamidine extension
Preventing primary VL (primary prophylaxis)	PreLeisH study (Northern Ethiopia): Multicentre observational cohort study HIV patients in HIV care and living in a VL-endemic area will be followed for 2 years with clinical/laboratory evaluation every 3 months. The incidence of asymptomatic Leishmania infection will be determined, and a clinical prediction tool to predict the onset of VL will be developed [15].

Abbreviations: ART, antiretroviral treatment; CD4, cluster of differentiation 4; IV, intravenously; PO, per os (oral treatment); VL, visceral leishmaniasis.