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

• Published in: The American journal of tropical medicine and hygiene Vol. 99; no. 6; pp. 1541 - 1546
• Main Authors: Guedes, Diego Lins, Medeiros, Zulma, Dionísio da Silva, Elis, Martins de Vasconcelos, Audrey Violeta, Santana da Silva, Mariana, Lopes da Silva, Maria Almerice, Ramos de Araújo, Paulo Sérgio, Miranda-Filho, Demócrito de Barros
• Format: Journal Article
• Language: English
• Published: United States Institute of Tropical Medicine 01-01-2018; The American Society of Tropical Medicine and Hygiene
• Subjects: Adolescent; Adult; Agglutination Tests; Brazil - epidemiology; Coinfection; Cross-Sectional Studies; Female; HIV; HIV - genetics; HIV - immunology; HIV - isolation & purification; HIV Infections - epidemiology; HIV Infections - parasitology; HIV Infections - physiopathology; HIV Infections - virology; Hospitalization; Human immunodeficiency virus; Humans; Leishmania - genetics; Leishmania - immunology; Leishmania - isolation & purification; Leishmaniasis, Visceral - epidemiology; Leishmaniasis, Visceral - parasitology; Leishmaniasis, Visceral - physiopathology; Leishmaniasis, Visceral - virology; Male; Middle Aged; Parasitic diseases; Polymerase Chain Reaction; Prevalence; Brazil
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.17-0787

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
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
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 (
= 0.004) and pallor (
= 0.009) were more frequent in the coinfected group. Serum albumin level was higher in coinfected individuals (
= 0.009). It is important to follow-up these individuals to understand the dynamics of VL in people living with HIV. New tests are necessary, ideally differentiating active from latent infection. Testing for VL in people with HIV is important and should be considered as part of the initial investigation in these individuals.