Leishmania-HIV Co-infection: Clinical Presentation and Outcomes in an Urban Area in Brazil

Submitted by Nuzia Santos ([email protected]) on 2015-02-19T15:24:11Z No. of bitstreams: 1 2014_085.pdf: 219256 bytes, checksum: a2c692be2c14cd0540105f2b7d277261 (MD5)Approved for entry into archive by Nuzia Santos ([email protected]) on 2015-02-19T15:24:19Z (GMT) No. of bitstreams: 1 2014_085.pdf: 219256 bytes, checksum: a2c692be2c14cd0540105f2b7d277261 (MD5)Approved for entry into archive by Nuzia Santos ([email protected]) on 2015-02-19T15:28:58Z (GMT) No. of bitstreams: 1 2014_085.pdf: 219256 bytes, checksum: a2c692be2c14cd0540105f2b7d277261 (MD5)Made available in DSpace on 2015-02-19T15:28:58Z (GMT). No. of bitstreams: 1 2014_085.pdf: 219256 bytes, checksum: a2c692be2c14cd0540105f2b7d277261 (MD5) Previous issue date: 2014Fundaçao Oswaldo Cruz. Centro de Pesquisas Rene Rachou. Laboratório de Pesquisas Clinicas. Belo Horizonte, MG, Brasil / Fundação Hospitalar do Estado de Minas Gerais. Hospital Eduardo de Menezes. Belo Horizonte, MG, Brasil.Universidade Federal de Minas Gerais. Programa de Pós Graduação em Ciências da Saúde. Belo Horizonte, Minas Gerais, Brasil.Fundação Hospitalar do Estado de Minas Gerais. Eduardo de Menezes Hospital. Belo Horizonte, MG, Brasil.Fundação Hospitalar do Estado de Minas Gerais. Eduardo de Menezes Hospital. Belo Horizonte, MG, Brasil.Fundação Hospitalar do Estado de Minas Gerais. Eduardo de Menezes Hospital. Belo Horizonte, MG, Brasil.Fundação Hospitalar do Estado de Minas Gerais. Eduardo de Menezes Hospital. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Centro de Pesquisas Rene Rachou. Laboratório de Pesquisas Clinicas. Belo Horizonte, MG, Brasil.BACKGROUND: Visceral leishmaniasis (VL) is an emerging condition affecting HIV-infected patients living in Latin America, particularly in Brazil. Leishmania-HIV coinfection represents a challenging diagnosis because the clinical picture of VL is similar to that of other disseminated opportunistic diseases. Additionally, coinfection is related to treatment failure, relapse and high mortality. OBJECTIVE: To assess the clinical-laboratory profile and outcomes of VL-HIV-coinfected patients using a group of non HIV-infected patients diagnosed with VL during the same period as a comparator. METHODS: The study was conducted at a reference center for infectious diseases in Brazil. All patients with suspected VL were evaluated in an ongoing cohort study. Confirmed cases were divided into two groups: with and without HIV coinfection. Patients were treated according to the current guidelines of the Ministry of Health of Brazil, which considers antimony as the first-choice therapy for non HIV-infected patients and recommends amphotericin B for HIV-infected patients. After treatment, all patients with CD4 counts below 350 cells/mm3 received secondary prophylaxis with amphotericin B. RESULTS: Between 2011 and 2013, 168 patients with suspected VL were evaluated, of whom 90 were confirmed to have VL. In total, 51% were HIV coinfected patients (46 patients). HIV-infected patients had a lower rate of fever and splenomegaly compared with immunocompetent patients. The VL relapse rate in 6 months was 37% among HIV-infected patients, despite receiving secondary prophylaxis. The overall case-fatality rate was 6.6% (4 deaths in the HIV-infected group versus 2 deaths in the non HIV-infected group). The main risk factors for a poor outcome at 6 months after the end of treatment were HIV infection, bleeding and a previous VL episode. CONCLUSION: Although VL mortality rates among HIV-infected individuals are close to those observed among immunocompetent patients treated with amphotericin B, HIV coinfection is related to a low clinical response and high relapse rates within 6 months