Visceral leishmaniasis in patients infected with the human immunodeficiency virus

Abstract

The experience with 52 episodes of visceral leishmaniasis diagnosed in 43 patients is reported. The most common symptoms were fever (81%), splenomegaly (65%), hepatomegaly (63%), and pancytopenia (73%). In 79% of the patients, CD4+ cell counts were < 100 cells/mm3. Prior or simultaneous diagnosis of AIDS was made in 29 (67%) patients. Diagnosis was considered fortuitous in 19% of the episodes. In 27% of the episodes, the diagnosis was made on the basis of demonstration of parasites outside the reticuloendothelial system, chiefly blood (7 cases) and gastrointestinal mucosa (5 cases). Parasites were frequently observed or cultured from blood (22/37 episodes) or the digestive tract (8/9 episodes). High antimony doses were more effective than low doses in achieving clinical or parasitological cure (rate of cure, 80% vs. 40%, p = 0.11). Severe toxicity was observed in six (11.7%) of the 51 treated episodes. Severe AIDS-related diseases [odds ratio (OR) 10, p < 0.05] and CD4+ counts (OR 12, p < 0.05) were independent factors for early death. Prophylaxis with monthly pentamidine was not useful in reducing relapses of visceral leishmaniasis.

The Relationship between Leishmaniasis and AIDS: the Second 10 Years

“…Clinical manifestations of VL caused by L. infantum and L. donovani in HIV-infected people are not significantly different from those in non-HIV-infected people (71,133,141,143,160,166,181,188,189,205,220,224,266). Classical features are fever, weight loss, hepatosplenomegaly, and pancytopenia.…”

“…At the time of diagnosis of the first episode of VL, 79 to 100% of HIV-positive patients coinfected with L. infantum had a CD4 ϩ cell count of Ͻ200 cells/l (133,141,166,188,189,205,224), and 42 to 72% of patients met the AIDS-defining criteria before or during the first episode of VL (133,141,160,166,189,205). The CD4 counts of those with L. donovani infection are not published.…”

Leishmaniosis visceral en un paciente con infección por VIH

“…Tiene el inconveniente de no estar disponible en la mayoría de los países en que la leishmaniosis es un problema endémico, por su alto costo, y de no permitir el estudio simultáneo de otros posibles patógenos como ocurre con la biopsia 4 . Esto último es muy importante sobre todo en los pacientes con VIH que pueden presentar co-infecciones con otros agentes oportunistas cuyos síntomas pueden sobreponerse, enmascararse o potenciarse entre sí [5][6][7] . El paciente presentado tenía un síndrome febril prolongado, forma frecuente de presentación de esta enfermedad, que comenzó con compromiso del estado general y baja de peso y continuó con sensación febril y diarrea.…”

Developments in the treatment of visceral leishmaniasis

“…Pentamidine is well-distributed in tissues and excreted very slowly [64,65]. Data on efficacy are scarce, but reduction of relapses and good tolerability of pentamidine monthly injections are reported [66][67][68]. These characteristics and its low toxicity in intermittent dosing regimen make it suitable for secondary prophylaxis.…”