General aspects of visceral leishmaniasis with or without HIV co-infection in Northeast Brazil

Abstract

BackgroundThe case of visceral leishmaniasis (VL) and human immunodeficiency virus (HIV) co-infection was reported in Spain first in 1985, and coincidence of these diseases has also been confirmed in more than 35 countries.\n\nMethodologyWe performed a comparative study in the states reference hospital for infectious/parasitic diseases, which treats adults with HIV/acquired immune deficiency syndrome (AIDS), between January 2007 and July 2017. The data obtained using this protocol were analyzed using SPSS.\n\nPrincipal findingsIn total, 163 patients were evaluated in this study, including 126 patients with coincident VL/HIV and 37 patients with VL alone. Both groups consisted primarily of male patients. The most commonly affected age group was 30-39 years (p < 0.001). Fever (p < 0.001) and hair loss (p = 0.007), which were more common in patients with VL alone, were more common. On hemogram, segmented neutrophils (p < 0.0001) were found to be more in the VL/HIV group than in the VL alone group. Additionally, AST and ALT levels differed between the groups (p < 0.001). On average, HIV was diagnosed 2.6 years before VL (p < 0.001). VL relapse was observed only in the co-infection group (36.5% of cases). Fever ({beta} = +0.17; p = 0.032) in the first VL/HIV episode was identified as a risk factor for relapse (R2 = 0.18). The death rate of co-infected patients was 11.1%.\n\nConclusion/SignificanceVL/HIV was prevalent among young adults, whereas the median patient age was higher in the VL group. The classic symptomatology of VL was more common in patients not co-infected with HIV, but attention is needed regarding the presence of fever in the first episode of VL as a risk factor for relapse in co-infected patients. No cases of VL relapse occurred in patients without HIV.\n\nAUTHOR SUMMARYVisceral Leishmaniasis (VL) and HIV have maintained increasing rates of populational occurrence in the Northeast region of Brazil, with advancing in rural areas and VL advancing in urban areas. This dynamic explains the increase of co-infection from 0.7% in 2001 to 8.5% in 2012. The state of Maranhao presents a large number of cases in the Northeast Brazil, a region with the majority of patients with this co-infection. The severity presented by these patients, in the observation of frequent relapses and high lethality, is presented in this study, which contributes to epidemiological, clinical, laboratorial, and evolutionary knowledge, trying to demonstrate these in the statistical data. Therefore, it should be pointed out that young adult patients with HIV/AIDS who present with any cytopenia, with or without hepatosplenomegaly and accompanied by fever or not, must be investigated for VL.