The Relationship between Leishmaniasis and AIDS: the Second 10 Years

Abstract

SUMMARY To date, most Leishmania and human immunodeficiency virus (HIV) coinfection cases reported to WHO come from Southern Europe. Up to the year 2001, nearly 2,000 cases of coinfection were identified, of which 90% were from Spain, Italy, France, and Portugal. However, these figures are misleading because they do not account for the large proportion of cases in many African and Asian countries that are missed due to a lack of diagnostic facilities and poor reporting systems. Most cases of coinfection in the Americas are reported in Brazil, where the incidence of leishmaniasis has spread in recent years due to overlap with major areas of HIV transmission. In some areas of Africa, the number of coinfection cases has increased dramatically due to social phenomena such as mass migration and wars. In northwest Ethiopia, up to 30% of all visceral leishmaniasis patients are also infected with HIV. In Asia, coinfections are increasingly being reported in India, which also has the highest global burden of leishmaniasis and a high rate of resistance to antimonial drugs. Based on the previous experience of 20 years of coinfection in Europe, this review focuses on the management of Leishmania-HIV-coinfected patients in low-income countries where leishmaniasis is endemic.

Transmission, reservoir hosts and control of zoonotic visceral leishmaniasis

“…Additional transmission routes include infection through blood transfusion from infected to uninfected hosts, both in foxhounds (Owens et al 2001) and humans (Otero et al 2000), human organ transplantation (Antinori et al 2008) and sexual transmission in dogs (Silva et al 2009) and humans (Symmers, 1960). Transmission via shared syringes is another possibility, and has been indicated amongst IV-drug users in southwest Europe (Cruz et al 2002 ;Alvar et al 2008). The possibility of transmission by non-sandfly vectors also has been considered (Dantas-Torres, 2006 ;Coutinho and Linardi, 2007).…”

Clinical risk factors for therapeutic failure in kala-azar patients treated with pentavalent antimonials in Nepal

“…Leishmania/HIV co-infected patients have low cure rates and almost all patients are known to relapse with any form of treatment. 14,15 Risk factors for mortality in VL patients have been related to anaemia, severe malnutrition and long duration of illness. 16 A significant association with treatment failure was also seen in patients presenting with a large spleen at presentation, reflecting more advanced disease.…”

Current diagnosis and treatment of cutaneous and mucocutaneous leishmaniasis

“…Data from HIV/Leishmania-infected individuals, based on observations in the Mediterranean area, showed a relatively low sensitivity [74]. However, in coinfected patients in Brazil, the sensitivity was not low, showing 77% positivity in serology [28].…”