Visceral leishmaniasis and HIV/AIDS in Brazil: Are we aware enough?

Abstract

BackgroundThe urbanization of visceral leishmaniasis (VL) and the concurrent movement of the HIV infection to rural areas in Brazil are possible mechanisms associated with an increased number of Leishmania/HIV coinfected people. This study aimed to describe the clinical and epidemiological profile of VL/HIV coinfected patients and compare this profile to non-coinfected VL patients.MethodsCases of VL/HIV coinfection were obtained through a probabilistic record linkage of databases of VL and AIDS cases from the Brazilian Ministry of Health.ResultsWe retrieved 760 cases of VL/HIV coinfection, most prevalent in adult males, with incidence ranging from 0.01 to 0.07 cases, per 100.000 population, in 2001 and 2010, respectively. Case-fatality rates were 27.3% in 2001 and 23.2% in 2010. Weakness, weight loss, cough, other associated infections and haemorrhagic phenomena were more commonly found among coinfected patients, which had a fatality rate three times higher as compared to the non-coinfected group. The relapse proportion was two times greater among coinfected (6.3%) than non-coinfected (3.1%).ConclusionsThe results found herein contribute to the increase of knowledge of the epidemiological situation of VL/HIV coinfection in Brazil and reinforce the necessity of implementing specific strategies to improve early case detection and efficacious and less toxic treatment in order to achieve lower case-fatality rates.

Social determinants of mortality due to visceral leishmaniasis in Brazil (2001-2015): an ecological study

“…Mortality due to leishmaniasis is considered to be potentially avoidable and is generally associated with malnutrition, late diagnosis, and HIV infection. Individuals with VL/HIV coinfection are three times more likely to die than the general population, and the lethality rate may reach 25% in coinfected individuals 5 . However, at the community level, other factors may be associated with the high disease burden and culminate in deaths.…”

“…Another important factor for the stable or even increasing trend of leishmaniasis mortality is the geographical overlap of leishmaniasis with major areas of HIV transmission 15 , since patients coinfected with HIV are at higher risk of death than non-coinfected patients 3,5 . Research conducted in Minas Gerais showed that the lethality due to leishmaniasis was 1.9 higher in HIV+ individuals, with an odds ratio (OR) of 10.9 and an unfavorable outcome up to 6 months after diagnosis 15 .…”

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

“…in a large portion of co-infected patients at the time of VL diagnosis 284[23,34,35,37,38]. However, we emphasize that the diagnosis of HIV having been 285 performed before VL in most co-infected patients, these patients should be 286 immunologically less suppressed since they would be taking antiretroviral, but most of 287 19 them had a viral load above 50 copies.…”

Predictors of relapse of visceral leishmaniasis in inner São Paulo State, Brazil

“…In the past two decades, Brazil witnessed changes in the epidemiology of VL, which moved from a rural endemic in poorest Northeastern States to an urban emerging disease spreading into the more developed Southeastern Region (Conti et al, 2016;Martins-Melo et al, 2018). In this new setting, the epidemics of VL and AIDS intertwined (Lindoso et al, 2014;Leite de Sousa-Gomes et al, 2017;Lindoso et al, 2018). Governmental guidelines for the therapy of VL and VL-HIV coinfection were expedited, but data concerning their efficacy are still limited (de Melo and Fortaleza, 2013).…”