Visceral Leishmaniasis in Hospitalized HIV-Infected Patients in Pernambuco, Brazil

Abstract

Common in four continents, visceral leishmaniasis (VL) is an important but neglected disease. Human immunodeficiency virus (HIV) infection increases the risk of developing VL in people from leishmaniasis-endemic areas, with worse prognosis when there is coinfection. We conducted a cross-sectional study to determine the prevalence of HIV/VL coinfection in patients admitted in three referral hospitals for HIV/acquired immunodeficiency syndrome (AIDS) in Pernambuco, Brazil, and to compare epidemiological, clinical, and laboratory characteristics among HIV/VL coinfected and HIV mono-infected individuals. The sample consisted of HIV patients aged 18 years or more, in a period of data collection of 6 months. We performed four Leishmania tests-polymerase chain reaction (PCR), direct agglutination test, rK39, and latex agglutination test-and individuals with at least one positive test were considered coinfected. The HIV/VL coinfection prevalence we found was 16.9%. We observed large variation in prevalence according to the Leishmania test used, with low coincidence of positive tests. The most frequent symptoms found were weight loss (75.6%), fever (67.6%), and cough (55.3%). When we compared HIV/VL coinfected and HIV mono-infected groups we did not observe statistically significant differences. Low educational level (P = 0.004) and pallor (P = 0.009) were more frequent in the coinfected group. Serum albumin level was higher in coinfected individuals (P = 0.

Asymptomatic Leishmania infection in HIV-positive outpatients on antiretroviral therapy in Pernambuco, Brazil

“…The prevalence of asymptomatic HIV- Leishmania coinfection in this study (9.1%) was lower than that in a previous study in Pernambuco of hospitalized HIV-positive patients who were tested for VL (16.9%) [ 18 ]. This previous study involved three referral hospitals for infectious diseases that serviced the entire state.…”

“…Individuals under treatment for VL and those with current VL symptoms were excluded. Based on a previous prevalence study in Pernambuco [ 18 ], the minimum sample size was calculated to be 159 individuals for a 95% confidence interval (Epi Info 7.2.3.0 software, https://www.cdc.gov/epiinfo/index.html ). We publicly invited patients at this outpatient clinic to participate in the study.…”

“…Asymptomatic Leishmania infected individuals, despite the typically low parasite load, might contribute to maintaining the transmission cycle of Leishmania parasites in endemic regions during episodes of increased parasite load and disease relapse [ 16 , 17 ]. In Brazil, due to the high prevalence of HIV- Leishmania coinfection observed in previous studies [ 10 , 15 , 18 ], and due to the other potential implications (e.g. frequent relapses, mother-to-child transmission [ 19 ]), testing for Leishmania should be strongly recommended for all HIV-positive individuals.…”

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.…”

Rapid Clinical Management of Leishmaniasis in Emergency Department: A Case Report with Clinical Review of Recent Literature

“…It has also been shown that HIV can lead to the re-activation of leishmania infection that was latent [ 7 , 8 , 9 ].…”