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

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. © 2014 cota et al.