Visceral Leishmaniasis and HIV Coinfection in Latin America

Abstract

Visceral leishmaniasis (VL) is an endemic zoonotic disease in Latin America caused by Leishmania (Leishmania) infantum, which is transmitted by sand flies from the genus Lutzomyia. VL occurs in 12 countries of Latin America, with 96% of cases reported in Brazil. Recently, an increase in VL, primarily affecting children and young adults, has been observed in urban areas of Latin America. The area in which this spread of VL is occurring overlaps regions with individuals living with HIV, the number of whom is estimated to be 1.4 million people by the World Health Organization. This overlap is suggested to be a leading cause of the increased number of reported VL-HIV coinfections. The clinical progression of HIV and L. infantum infections are both highly dependent on the specific immune response of an individual. Furthermore, the impact on the immune system caused by either pathogen and by VL-HIV coinfection can contribute to an accelerated progression of the diseases. Clinical presentation of VL in HIV positive patients is similar to patients without HIV, with symptoms characterized by fever, splenomegaly, and hepatomegaly, but diarrhea appears to be more common in coinfected patients. In addition, VL relapses are higher in coinfected patients, affecting 10% to 56.5% of cases and with a lethality ranging from 8.7% to 23.5% in Latin America, depending on the study. With regards to the diagnosis of VL, parasitological tests of bone marrow aspirates have proven to be the most sensitive test in HIV-infected patients. Serologic tests have demonstrated a variable sensitivity according to the method and antigens used, with the standard tests used for diagnosing VL in Latin America displaying lower sensitivity. For this review, few articles were identified that related to VL-HIV coinfections and originated from Latin America, highlighting the need for improving research within the regions most greatly affected. We strongly support the formation of a Latin American network for coinfections of Leishmania and HIV to improve the consistency of research on the current situation of VL-HIV coinfections. Such a network would improve the collection of vital data and samples for better understanding of the clinical manifestations and immunopathogenic aspects of VL in immunosuppressed patients. Ultimately, a concerted effort would improve trials for new diagnostic methodologies and therapeutics, which could accelerate the implementation of more specific and effective diagnosis as well as public policies for treatments to reduce the impact of VL-HIV coinfections on the Latin American population.

Predicting death from kala-azar: construction, development, and validation of a score set and accompanying software

“…Both are important opportunistic infections among patients with acquired immunodefi ciency syndrome (AIDS) (14) (15) (16) and have similar clinical presentations, but L. donovani may lead to post-kala-azar dermal leishmaniasis, or infectious skin lesions (17) (18) .…”

Diagnosing Neglected Tropical Diseases in HIV Coinfection

“…Concerning VL-HIV coinfection, the typical form, characterized by fever, splenomegaly, and hepatomegaly, is more common. [80][81][82][83] However, atypical manifestations, including the involvement of the gastrointestinal tract and kidneys, have been reported, whereas diarrhea and cough are more prevalent in HIV-VL coinfected patients. 84,85 Regarding TL in HIV-infected patients, there are few reports in the literature.…”

Frequência da infecção por Leishmania spp. em pacientes com HIV/aids vivendo em área urbana

“…HIV/aids e LV compartilham mecanismos imunes semelhantes e a coinfecção contribui para a progressão de ambas as doenças (Alvar et al, 1997;Lindoso et al, 2014). A presença do HIV aumenta a fagocitose de Leishmania pelos macrófagos e facilita o crescimento intracelular do parasito, com aumento da produção de interleucina-4 e interleucina-10.…”

“…A presença do HIV aumenta a fagocitose de Leishmania pelos macrófagos e facilita o crescimento intracelular do parasito, com aumento da produção de interleucina-4 e interleucina-10. Além disso, presença de Leishmania também favorece a infecção pelo HIV, induzindo a sobrevivência e proliferação de monócitos infectados, inibindo a apoptose de macrófagos e contribuindo para a elevação da expressão do vírus (Jarvis e Lockwood, 2013;Lindoso et al, 2014 (Alvar et al, 1997;Cruz et al, 2006;World health organization, 2010). Esse mesmo cenário também ocorre nos países da América Latina, onde a disseminação da infecção pelo HIV para áreas rurais e a urbanização da LV, contribuem para o cruzamento de áreas de transmissão de ambas as doenças e consequentemente para aumento da prevalência da coinfecção Van Griensven et al, 2014).…”

“…Apesar de reconhecidamente os testes sorológicos apresentarem sensibilidade mais baixa em pacientes com LV clinicamente manifesta infectados pelo HIV, há pouca informação sobre a comparação entre os diversos métodos sorológicos nesse contexto de imunodepressão e poucos estudos que incluam pacientes assintomáticos (Carranza-Tamayo et al, 2009;Cota et al, 2012;Orsini et al, 2012;Lindoso et al, 2014). Em estudo realizado em população de pessoas com HIV/aids acompanhadas em um hospital de nível terciário, no Distrito Federal, foi identificada prevalência de infecção assintomática por Leishmania em 16% dos pacientes (Carranza-Tamayo et al, 2009), revelando a importância da coinfecção nesse cenário.…”