Epidemiological profile and lethality of visceral leishmaniasis/human immunodeficiency virus co-infection in an endemic area in Northeast Brazil

Abstract

INTRODUCTION: The association of visceral leishmaniasis (VL) and human immunodeficiency virus (HIV) infection is a concern worldwide, and this co-infection is linked to increased lethality. The Northeast is the region that mostly reports cases of VL in Brazil. The knowledge of risk factors associated with VL/HIV co-infection and its impact on lethality is extremely important. METHODS: The present study analyzed the epidemiologic features of cases with VL/HIV co-infection in the state of Pernambuco, Northeast of Brazil, from 2014 to 2018. RESULTS: There were 858 and 11,514 reported cases of VL and HIV infection, respectively. The average incidences of VL and HIV infection were 1.82 and 24.4/100,000 inhabitants, respectively. Of all reported cases of VL, 4.9% (42/858) also had HIV infection. There was an inverse spatial association between VL and HIV infection incidences. The lethality rates of VL, HIV infection, and co-infection were 9.9%, 26.1%, and 16.6%, respectively. Most of the patients were males and lived in urban areas. The cases of VL mostly occurred in children aged below 10 years, whereas the cases of HIV infection and VL/HIV co-infection were primarily observed in adults between 20 years and 39 years old. CONCLUSIONS: We defined the profile and areas with most cases of co-infection and found that the lethality of VL with co-infection increased in the current period. These findings contribute to applying efforts with a greater focus in these identified populations to prevent future deaths.

Epidemiological and clinical factors associated with lethality from Human Visceral Leishmaniasis in Northeastern Brazil, 2007 to 2018

“…The VL-HIV coinfection requires characterization, identification and resolution of the difficulties to restrain the progression of both diseases. Previous studies have detected an increased case fatality rate, ranging from 4.6% to 16.6% in coinfected patients in the Northeast region, specifically in the states of Rio Grande do Norte 4 and Pernambuco 29 ; as well as in the Minas Gerais State (13.0%), in the Southeastern region 14 . This is explained by the fact that both diseases cause infection and multiply in the lymphoid cells.…”

Prevalence of visceral leishmaniasis among people with HIV: a systematic review and meta-analysis

“…The lethality of VL increases by 4.6% to 16.6% when associated with HIV infection [62]. The presence of HIV can lead to severe forms of VL, which are difficult to control and manage.…”

“…The presence of HIV can lead to severe forms of VL, which are difficult to control and manage. Furthermore, PWH are more likely to have severe and/or prolonged VL with a more difficulty treatment course, which further may increase the HIV replication and the clinical evolution of AIDS [62]. Therefore, this coinfection warrants concern and must be recognized and treated in a timely manner.…”

Clinical-epidemiological characteristics of patients coinfected with human immunodeficiency virus and visceral leishmaniasis who attend at the Instituto de Medicina Tropical, during the years 2016 to 2020

“…Nuestro estudio presenta un grupo de pacientes coinfectados con leishmaniasis visceral y VIH en el Instituto de Medicina Tropical donde se observó que la coinfección afectó preferentemente al grupo etario comprendido entre 21-40 años, y al sexo masculino, coincidente con reportes de Machado et al (12), y Viana et al (13). Esto corrobora los datos analizados en todo el mundo, donde la mayoría de los casos de coinfección se dan en hombres adultos jóvenes (14,15).…”