Evaluation of HIV-Leishmania co-infection in patients from the northwestern Paraná State, Brazil

Abstract

ABSTRACT. Leishmaniasis occurs throughout the world and is one of the opportunistic infections that attack HIV-infected individuals. Few data are available on American cutaneous leishmaniasis (ACL) in HIV-infected patients. Current research investigates the occurrence of HIV-Leishmania co-infection in HIV-infected individuals in an endemic region in Southern of Brazil. A non-randomized transversal investigation, molecular and serum epidemiologic type, on the occurrence of ACL in 169 HIV-infected patients was undertaken. The patients were followed up at the Integrated Nucleus of Health of the city Maringá, Southern of Brazil. Results showed that 13 (7.7%) of the HIV-infected patients also presented Leishmania (Viannia) DNA, detectable in blood by PCR. Serology, direct research, culture and PCR in skin material produced negative results. PCR positiveness for Leishmania was not associated with CD4 T lymphocytes count, opportunistic disease, treatment, use of proteases inhibitors, tattooing/piercing or use of injectable drugs, residential environment or previous ACL history. Results show that HIVinfected patients who live in endemic areas may reveal Leishmania DNA in the blood without any ACL symptoms. Above findings may be attributed to anti-retrovirus medicine that controls viral replication and maintains the functionality of the immune system and to a possible antiLeishmania activity of these drugs.Keywords: american cutaneous leishmaniasis, HIV, co-infection, polymerase chain reaction.RESUMO. Avaliação da co-infecção HIV-Leishmania em pacientes da região noroeste do Estado do Paraná, Brasil. As leishmanioses ocorrem em todo o mundo e são infecções oportunistas que afetam indivíduos portadores do vírus HIV. Este estudo investigou a ocorrência da co-infecção HIV-Leishmania em portadores do HIV numa região endêmica para LTA do Sul do Brasil. Foi realizado estudo transversal, não randomizado, utilizando metodologia molecular e sorológica, sobre a ocorrência de LTA em 169 portadores do HIV. Foram estudados pacientes atendidos no Núcleo Integrado de Saúde de Maringá, Paraná, Sul do Brasil. Observou-se que 13 (7,7%) dos pacientes infectados pelo HIV também apresentavam o DNA de Leishmania (Viannia), detectável no sangue por PCR. A sorologia, pesquisa direta de Leishmania, cultura e PCR de lesões de pele foram negativas. A positividade da PCR não estava associada à contagem de linfócitos T CD4 + , doença oportunista, tratamento, uso de inibidores de protease, tatuagem, uso de drogas injetáveis, ambiente da residência ou história prévia de LTA. Os resultados mostraram que indivíduos portadores do vírus HIV que residem em área endêmica podem apresentar o DNA de Leishmania sem manifestar sintomas de LTA. Estes resultados podem ser atribuídos a ação dos medicamentos anti retrovirais que controlam a replicação viral mantendo a integridade do sistema imunológico ou a uma possível atividade anti-Leishmania destas drogas.Palavras-chave: leishmaniose tegumentar americana, HIV, co-infecção, reação em cadeia da polimerase.

Visualizing the In Vivo Dynamics of Anti-Leishmania Immunity: Discoveries and Challenges

“…Persistent parasites have been detected in three-year old skin lesions ( 54 ) as well as in extralesional sites ( 55 , 56 ), and can contribute to a late cutaneous manifestation of visceral leishmaniasis, termed post-kala-azar dermal leishmaniasis (PKDL) ( 57 , 58 ) in humans. Numerous factors allowing the parasites to persist have been speculated ( 59 ), and these observations indicate that while the presence of live parasites may generate immunity against re-infections, there is inherent risk for disease reactivation, especially in immunocompromised individuals ( 60 , 61 ). This has been demonstrated in mice, where the expansion of Treg cells in vivo causes reactivation of disease in tissues at the site of primary skin infection long after it has healed ( 62 ), while depleting Tregs during the secondary challenge prevents disease reactivation at the site of infection and enhances early parasite clearance ( 63 , 64 ).…”