AEGiS-14IAC: Visceral Leishmaniasis: A comparative study of patients with and without Human Immunodeficiency Virus infection.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Visceral Leishmaniasis: A comparative study of patients with and without Human Immunodeficiency Virus infection.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. WeOrC1377)

Takeda CF, Cartaxo LA, Ponte GA, Sa AP, Mesquita JR, Oliveira RP Jr.
Hospital Sao Jose de Doencas Infecciosas/ Secretaria de Saude do Estado do Ceara, Fortaleza, Brazil

BACKGROUND: Visceral leishmaniasis (VL) is a worldwide disseminated protozoal infection, endemic in Brazil, associated with considerable morbidity. For the last twenty years it has been reported as a common complication of patients infected with human immunodeficiency virus (HIV) mainly in the Mediterranean area. The clinical presentation and outcome of VL in HIV-infected patients are not well known and few comparative studies have been done. This study also highlights the increasing incidence of HIV-VL coinfection in Brazil due to the spread of HIV to rural areas and the VL to suburban areas.

METHOD: We retrospectively studied the characteristics of VL in patients with and without HIV infection, between 1995-2001, performed in a referral hospital in the Northeast of Brazil. We used Fisher exact test in all those cell values less than 5.

RESULTS: It was diagnosed 75 episodes of VL in 69 patients. Eleven (15.95%) were coinfected, 75% of them had AIDS, and the mean CD4+ lymphocytes count was 146.47/mm³. The mean age at diagnosis was higher in HIV-infected patients (32.54 versus 20.98 yr), and the ratio male/female was similar in both groups. The bone marrow aspirate was positive in 78.9% non coinfected versus 90.9% coinfected patients. Clinical and laboratory data were similar to patients non HIV- infected, except for the lower frequency of splenomegaly (p=0,0000275) and higher relapse rate (p=0.0031). Mortality was higher in the HIV-infected group(p=0.000227). Five deaths in the HIV-infected group were directly attributed to VL.

CONCLUSIONS: There were no major differences in clinical manifestations or laboratory data between the two groups. Mortality and relapses are more common in HIV patients. This coinfection behaves as opportunistic infection, usually affecting HIV- infected patients with severe immunodepression.

Keywords: AEGIS, Leishmaniasis, Visceral, HIV Infections, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Recurrence, Brazil, Mediterranean Sea, Female, Human, Male

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WeOrC1377