Asymptomatic Leishmania infection in HIV-positive outpatients on antiretroviral therapy in Pernambuco, Brazil

Abstract

Background Visceral leishmaniasis (VL) in HIV-positive individuals is a global health problem. HIV-Leishmania coinfection worsens prognosis and mortality risk, and HIV-Leishmania coinfected individuals are more susceptible to VL relapses. Early initiation of antiretroviral therapy can protect against Leishmania infection in individuals living in VL-endemic areas, and regular use of antiretrovirals might prevent VL relapses in these individuals. We conducted a cross-sectional study in Petrolina, Brazil, an VL-endemic area, to estimate the prevalence of asymptomatic Leishmania cases among HIV-positive outpatients. Methods We invited any HIV-positive patients, aged ≥ 18-years-old, under antiretroviral therapy, and who were asymptomatic for VL. Patients were tested for Leishmania with enzyme-linked immunosorbent assays (ELISA)-rK39, immunochromatographic test (ICT)-rK39, direct agglutination test (DAT), latex agglutination test (KAtex), and conventional polymerase chain reaction (PCR). HIV-Leishmania coinfection was diagnosed when at least one VL test was positive. Results A total of 483 patients were included. The sample was predominantly composed of single, < 48-years-old, black/pardo, heterosexual males, with fewer than 8 years of schooling. The prevalence of asymptomatic HIV-Leishmania coinfection was 9.11% (44/483). HIV mono-infected and HIV-Leishmania coinfected groups differed statistically significantly in terms of race (p = 0.045), marital status (p = 0.030), and HIV viral load (p = 0.046). Black/pardo patients, married patients, and those with an HIV viral load up to 100,000 copies/ml presented higher odds for HIV-Leishmania coinfection. Conclusions A considerable number of asymptomatic Leishmania cases were observed among HIV-positive individuals in a VL-endemic area. Given the potential impact on transmission and health costs, as well as the impact on these coinfected individuals, studies of asymptomatic Leishmania carriers can be useful for guiding public health policies in VL-endemic areas aiming to control and eliminate the disease.

Identification of asymptomatic Leishmania infections: a scoping review

“…Of note, the majority of the studies performed in an HIV-positive population included in this scoping review were conducted in the WHO European Region, the area where most HIV cases have been reported [ 120 ]. However, over the years, there has been an increase in HIV cases in other Leishmania -endemic areas, such as Brazil, East Africa, and India [ 13 , 116 ].…”

Análise dos perfis epidemiológicos da leishmaniose visceral e da coinfecção leishmaniose visceral-HIV no Piauí, 2007 a 2019

“…Quando a LV ocorre em indivíduos infectados pelo HIV, o prognóstico é tipicamente ruim e a taxa de mortalidade é alta. As taxas de letalidade e a recidiva refletem a importância da detecção e tratamento precoce do HIV em pacientes com LV, a fim de iniciar o tratamento adequado e prevenir a mortalidade (Guedes et al, 2021).…”

“…A identificação de novos casos que possam delimitar a doença ativa, sugerir cura e prever recidivas é urgente. Portanto, pode ser um desafio distinguir os casos de LV ativos de outra infecção oportunista, e políticas públicas de saúde para LV podem ajudar os profissionais de saúde a fazer diagnósticos mais precisos e, consequentemente, evitar tratamentos desnecessários (Guedes et al, 2021;Brasil, 2015).…”

Comparison of serum cytokine levels in symptomatic and asymptomatic HIV-Leishmania coinfected individuals from a Brazilian visceral leishmaniasis endemic area

“…For the symptomatic group, we used samples of the 35 VL-HIV coinfected patients diagnosed in a previous study in 2014 in three referral hospitals from Recife, Brazil [ 26 ]. For the asymptomatic group, we randomly selected samples of asymptomatic VL-HIV cases in 2018 attending an HIV outpatient service in Petrolina, Brazil [ 27 ]. All samples were stored in freezer (-80°C).…”