A Retrospective Analysis Comparing Treatment Response for Visceral Leishmaniasis-HIV Co-Infected Patients from the New World

Abstract

Background: Visceral Leishmaniasis and Human Immunodeficiency Virus co-infection (VL-HIV) occurs mainly in risk groups for HIV/AIDS (youth adult males). These co-infected individuals have greater mortality and relapses rates compared to VL as they share similar immune pathogenic mechanisms. Interest in co-infection VL/HIV and the lack of data in the literature led the authors to a survey on the subject comparing outcomes in VL-HIV co-infected treated with different drugs anti-Leishmania used in Brazil, such that Pentavalent Antimoniate (MA), Amphotericin B deoxicolate (AmBd), and liposomal Amphotericin B (LAmB).Methods: A retrospective descriptive study using routine program data was performed comparing drugs used for treatment of co-infected patients in Sao Paulo state, Brazil, among 1999-2010, observing their outcomes (cure, failure, relapse or death), and analyzing them by each drug used.Results: In the period of twelve years were reported 1,614 VL cases in Sao Paulo state from whom 1 070 (66.30%) were HIV-negative, 117 (7.25%) were HIV-positive and in 427 patients (26.45%) HIV status was unknown. To compare treatment response according to drugs used, we included only the 117 VL/HIV co-infected patients. Related to demographic data we found 72.65% (85/117) of males and 80.34% (94/117) of young adults (21-50 years old). From 117 co-infected patients, 95 had complete data of the treatment performed and these were included in the analysis. The lethality of VL-HIV co-infected patients was 24.2% (23/95) and general relapse rate was 10.5% (10/95). Deaths in co-infected were more prevalent among 31-50 years. According to drug used, 35.64% (36/101) were treated with pentavalent antimoniate (20 mg/kg/day per 28 days), 12 (11%) received Amphotericin B deoxicolate (AmBd) (total dose: 20 to 24 mg/kg) and 47 were treated with Liposomal amphotericin B (LAmB) (total dose: 20 to 24 mg/kg). Patients treated with PA presented similar cure rates compared to LAmB. Patients treated with AmBd had higher lethality and patients treated with LAmB had no failures. Conclusion:High lethality and relapses rates occur in VL-HIV co-infected patients. Poor outcome leading to death was observed in AmBd group. There is an urgent necessity to perform prospective clinical trials to evaluate the safety and efficacy of different schemes for treatment of co-infected patients, especially in New World.

Impact of Insulin Resistance on Therapeutic Response to Oral Treatment of Chronic Hepatitis C Virus Infection

“…A previous study, matching ours, reported that age was a positive predictor of response at SVR12 and SVR24. However, given that the odds ratio (1.03) was very small, and that advanced age rarely leads to better clinical outcomes, this was likely statistical noise due to small power rather than a real effect of the predictor [12] .…”

Case Report: Severe Visceral Leishmaniasis in a Patient with HIV Coinfection Undergoing Treatment for Erythema Nodosum Leprosum

“…7 In addition, elevated parasite load is a common finding in coinfected patients, due to the compromised immune system (reduced monocyte and macrophage function) and stimulation of viral replication. 8,9 Serological tests for antibodies normally show low performance for VL/HIV coinfected patients. Freire et al 10 demonstrated that, among serological tests available in Brazil for diagnosing VL, DAT showed the highest sensitivity in individuals with coinfection, and immunochromatographic assay (IT LEISH, rk39) showed sensitivity of only 63.2%.…”

“…24,25 In individuals with VL-HIV coinfection, the chance of recurrence of VL is five times greater than in individuals without coinfection. 9 The high rate of recurrence may be associated with the inability to control replication of parasites due to an ineffective immune response mediated by Leishmaniaspecific lymphocytes, resulting from immunodeficiency caused by HIV. 26 In the reported case, the patient showed clinical worsening 6 months after treatment of VL, as he did not follow up with secondary prophylaxis.…”