AEGiS-13IAC: Leishmania and HIV infection: A colaborative study of 228 episodes in a Spanish mediterranean area.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Leishmania and HIV infection: A colaborative study of 228 episodes in a Spanish mediterranean area.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. TuOrB357)

Francisco P, Javier E, Rosario S, Jose Maria C, Juan F, Caridad R, Jose L, Vicente A, Jose Adolfo O; P. Francisco, Hospital Marina Baixa, Partida Galande No 5, 03570 Villajoyosa, Alicante, Spain, Tel.: +34 96 685 98 47, Fax: +34 96 685 99 00, E-mail: pasquau_fra@gva.es

BACKGROUND: Leishmania is a common infection in patients infected with HIV living in Mediterranean areas. We describe the clinico-epidemiological characteristics, determinants for relapse and survival of HIV and Leishmania infection in a large cohort of patients from a Spanish Mediterranean area.

METHODS: Retrospective chart review from years 1987 to 1999 of patients with Leishmania and HIV infection. Cases were diagnosed by the visualisation of Leishmania amastigotes in bone marrow (n = 199) and/or other samples (n = 41) in 16 hospitals from the Autonomous Communities of Valencia and Murcia (Spain).

RESULTS: A total of 160 patients and 228 episodes of Leishmania and HIV infection were identified. Leishmania was diagnosed in 3.4% (range 0.6-8.2%) of the HIV population cared by the participating hospitals. Patients characteristics were: mean age 34 years, male gender in 82%, drug addiction as transmission category in 73%. 88% of patients had less than 200 CD4 cells ó Ç Ö 106 /L and 61% had previous AIDS-defining events. Splenomegaly, anaemia, low WBC count were the most common clinical and laboratory findings. Absence of fever was observed in 24%. Hypergammaglobulinemia was observed in only 40%. A total of 41 (26%) patients had more than 1 episode of Leishmania infection (range 2-6). Significant determinants for relapse were: female gender (HR: 1.77, CI: 1.12-2.79, p = 0.01), a non-completed therapy for Leishmania infection (HR: 1.60, CI: 1.05-2.42, p = 0.02) and absence of secondary prophylaxis for Leishmania (HR: 2.06, CI: 1.45-2.94, p = 0.0001). A total of 86 (54%) patients died. In multivariate analysis, survival of patients with Leishmania as first opportunistic infection was similar to patients with Leishmania and other AIDS-defining illness (median days 303 vs. 257, p = 0.11). Significant determinants for survival were: CD4 cell count (HR: 0.99, CI: 0.99-0.99, p = 0.01) and secondary prophylaxis for Leishmania (HR: 0.83, CI: 0.73-0.94, p = 0.001).

CONCLUSION: Episodes of Leishmania infection occur in late HIV disease. Leishmania infection in HIV patients has often a relapsing course. Secondary prophylaxis reduces the risk for relapse. Patients with Leishmania infection had a similar survival to other AIDS indicator diseases. Therefore, Leishmaniasis in HIV infected patients should be considered as AIDS-defining illness.

Keywords: AEGIS, HIV Infections, Leishmania, Leishmaniasis, Acquired Immunodeficiency Syndrome, CD4 Lymphocyte Count, Retrospective Studies, Spain, Mediterranean Sea, Human, Animal, Female, Male
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TuOrB357