Visceral leishmaniasis and HIV coinfection: current perspectives

Abstract

Visceral leishmaniasis (VL) is caused by Leishmania donovani and Leishmania infantum. The burden of VL is concentrated in tropical and subtropical areas; however, HIV infection has spread VL over a hyperendemic area. Several outcomes are observed as a result of VL–HIV coinfection. Impacts are observed in immunopathogenesis, clinical manifestation, diagnosis, and therapeutic response. Concerning clinical manifestation, typical and unusual manifestation has been observed during active VL in HIV-infected patient, as well as alteration in immunoresponse, inducing greater immunosuppression by low CD4 T-lymphocyte count or even by induction of immunoactivation, with cell senescence. Serological diagnosis of VL in the HIV-infected is poor, due to low humoral response, characterized by antibody production, so parasitological methods are more recommended. Another important and even more challenging point is the definition of the best therapeutic regimen for VL in HIV-coinfected patients, because in this population there is greater failure and consequently higher mortality. The challenge of better understanding immunopathogenesis in order to obtain more effective therapies is one of the crucial points to be developed. The combination of drugs and the use of secondary prophylaxis associated with highly active antiretroviral therapy may be the best tool for treatment of HIV coinfection. Some derivatives from natural sources have action against Leishmania; however, studies have been limited to in vitro evaluation, without clinical trials.

Quality of life perceptions amongst patients co-infected with Visceral Leishmaniasis and HIV: A qualitative study from Bihar, India

“…Respondents ranged in age from 23 years to 64 years ( Table 1). Among 29 patients, 24 were men (83%) and 5 were women (17%), reflecting the background distribution of KA-HIV patients overall [22].…”

Strongyloides stercoralis infection in human immunodeficiency virus‐infected patients and related risk factors: A systematic review and meta‐analysis

“…The results obtained from this systematic review showed that the prevalence rate of S. stercoralis in HIV + patients using serological method (12.4%) was higher than other methods (3.6% microscopy, 10.8% culture and 3.9% molecular assays). According to our litterateur's review, the prevalence obtained though in general serological assays for detection of pathogens can yield a low sensitivity in HIV + individuals due to the potentially reduced humoral immune response (Lindoso, Moreira, Cunha, & Queiroz, ; Segarra‐Newnham, ). This is not attributed to certain diagnostic tests being preferred for studies in different regions since all described tests have used widely in different regions (Table , Figures ).…”

Higher levels of TNF and IL‐4 cytokines and low miR‐182 expression in visceral leishmaniasis‐HIV co‐infected patients

“…Clinical and laboratory findings included greater weight loss in HIV mono‐infected patients. Other studies have observed a greater proportion of weight loss in VL‐HIV co‐infected compared with HIV mono‐infected patients . This divergence could be explained by the fact that in our study, the HIV group included a larger number of individuals with discontinued use of HAART compared with the VL‐HIV group.…”