Epidemiological profile of patients co-infected with visceral leishmaniasis and HIV/AIDS in Northeast, Brazil

Abstract

Introduction: Visceral leishmaniasis (VL) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/ AIDS) co-infection has been a research topic of interest worldwide. In Brazil, it has been observed that there is a relative underreporting and failure in the understanding and management of this important association. The aim of this study was to analyze epidemiological and clinical aspects of patients with VL with and without HIV/AIDS. Methods: We conducted an observational and analytical study of patients with VL followed in a Reference Service in the State of Maranhão, Brazil from 2007-2013. Results: In total 126 patients were enrolled, of which 61 (48.4%) were co-infected with HIV/AIDS. There were more males among those with HIV/AIDS (85.2%, P>0.05) or with VL only (81.5%, P>0.05). These findings significantly differed based on age group (P<0.003); the majority of patients were aged 31-40 years (41.0%) and 21-30 years (32.3%) among those with and without HIV/AIDS co-infection, respectively. The incidence of diarrhea and splenomegaly significantly differed between the two groups (P=0.0014 and P=0.019, respectively). The myelogram parasitic examination was used most frequently among those with HIV/AIDS (91.8%), followed by those with VL only (69.2%). VL recurrences and mortality were significantly higher in the HIV/AIDS co-infected patients (P<0.0001 and P=0.012, respectively). Conclusions: Patients with VL with or without HIV/AIDS co-infection were mostly adult men. Diarrhea was more frequent in HIV/AIDS co-infected patients, whereas splenomegaly was more common in patients with VL only. In the group of HIV/AIDS co-infected patients, there was a higher rate of VL recurrence and mortality.

Epidemiological, clinical and laboratory aspects of human visceral leishmaniasis (HVL) associated with human immunodeficiency virus (HIV) coinfection: a systematic review

“…With the presence of HIV, the risk of coinfection increases from 100 to 2320 times. In endemic countries, the rate is between 2 and 9%, but in neglected populations, this rate may be even higher if it is not on the list of opportunistic diseases associated with HIV (Viana et al ., 2017).…”

“…With the presence of HIV, the risk of coinfection increases from 100 to 2320 times. In endemic countries, the rate is between 2 and 9%, but in neglected populations, this rate may be even higher if it is not on the list of opportunistic diseases associated with HIV (Viana et al, 2017). Geographical overlap of HVL and the HIV, the consequent emergence of coinfection of these diseases, has become a public health problem with high morbidity and mortality rates (Alvar et al, 2008;Martins-Melo et al, 2014).…”

Visceral leishmaniasis in Northeast Brazil: What is the impact of HIV on this protozoan infection?

“…Many Brazilian studies have reported the presence of splenomegaly followed by fever, weight loss, and asthenia. Nonetheless, in 81 patients with VL/HIV coinfection in Ceará [30] and in another study that identified weight loss, weakness, fever, and hepatosplenomegaly as the most common physical changes in 65 patients with VL/HIV coinfection [31], the most common symptoms were skin pallor, hepatomegaly, and splenomegaly, followed by weight loss and fever. These findings emphasize a low proportion of patients with splenomegaly (57.9%) when compared to patients with VL without HIV (84.9%), which is different from what was observed by Sousa-Gomes et al .…”

General aspects of visceral leishmaniasis with or without HIV co-infection in Northeast Brazil

“…In their study, fever was 250 observed more frequently in patients with VL than those with VL/HIV co-infection, [23,28]. Different 254 from many Brazilian studies, which reported the presence of splenomegaly followed by 255 fever, weight loss, and asthenia, in 81 patients with VL/HIV co-infection in Ceará [29] 256 and another study that identified weight loss, weakness, fever, and hepatosplenomegaly 257 as the most common physical changes in 65 patients with VL/HIV co-infection [13], the 258 most common symptoms in this study were skin pallor, hepatomegaly, and levels observed in some patients with VL/HIV co-infection [33,34,35] was also found in 279 the present study. However, we should note that such an increase was higher in patients 280 with VL alone, as additionally reported by De Souza et al and Cota et al [25,36].…”