Guidelines on opportunistic infections recommend that patients with visceral leishmaniasis and a CD4+ cell count < 200 cells/mm3 should receive an effective antileishmanial drug every 2-4 weeks (Table 12) (Management Guidelines)[CDC OI](Management Guidelines)[EACS]
Patients with cutaneous leishmaniasis who experience multiple relapses should also receive secondary prophylaxis
No formal recommendations for discontinuation of secondary prophylaxis, although guidelines note that withdrawal may be considered in patients whose CD4+ cell count increases to > 200 to 350 cells/mm3 for > 3-6 months following initiation of ART and who are negative for urinary Leishmania antigen and blood PCR (Table 13)[CDC OI; GESIDA OI]
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