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Leishmania-HIV co-infection: clinical presentation and outcomes in an urban area in Brazil.
PLoS Negl Trop Dis. 2014 Apr; 8(4):e2816.PN

Abstract

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.

Authors+Show Affiliations

Laboratory of Clinical Research - Centro de Pesquisas René Rachou - Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil; Eduardo de Menezes Hospital - Fundação Hospitalar do Estado de Minas Gerais-FHEMIG, Belo Horizonte, Minas Gerais, Brazil.Post-Graduate Program in Adult Health Sciences - Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.Eduardo de Menezes Hospital - Fundação Hospitalar do Estado de Minas Gerais-FHEMIG, Belo Horizonte, Minas Gerais, Brazil.Eduardo de Menezes Hospital - Fundação Hospitalar do Estado de Minas Gerais-FHEMIG, Belo Horizonte, Minas Gerais, Brazil.Eduardo de Menezes Hospital - Fundação Hospitalar do Estado de Minas Gerais-FHEMIG, Belo Horizonte, Minas Gerais, Brazil.Eduardo de Menezes Hospital - Fundação Hospitalar do Estado de Minas Gerais-FHEMIG, Belo Horizonte, Minas Gerais, Brazil.Laboratory of Clinical Research - Centro de Pesquisas René Rachou - Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24743472

Citation

Cota, Gláucia F., et al. "Leishmania-HIV Co-infection: Clinical Presentation and Outcomes in an Urban Area in Brazil." PLoS Neglected Tropical Diseases, vol. 8, no. 4, 2014, pp. e2816.
Cota GF, de Sousa MR, de Mendonça AL, et al. Leishmania-HIV co-infection: clinical presentation and outcomes in an urban area in Brazil. PLoS Negl Trop Dis. 2014;8(4):e2816.
Cota, G. F., de Sousa, M. R., de Mendonça, A. L., Patrocinio, A., Assunção, L. S., de Faria, S. R., & Rabello, A. (2014). Leishmania-HIV co-infection: clinical presentation and outcomes in an urban area in Brazil. PLoS Neglected Tropical Diseases, 8(4), e2816. https://doi.org/10.1371/journal.pntd.0002816
Cota GF, et al. Leishmania-HIV Co-infection: Clinical Presentation and Outcomes in an Urban Area in Brazil. PLoS Negl Trop Dis. 2014;8(4):e2816. PubMed PMID: 24743472.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Leishmania-HIV co-infection: clinical presentation and outcomes in an urban area in Brazil. AU - Cota,Gláucia F, AU - de Sousa,Marcos R, AU - de Mendonça,Andrea Laender Pessoa, AU - Patrocinio,Allan, AU - Assunção,Luiza Siqueira, AU - de Faria,Sidnei Rodrigues, AU - Rabello,Ana, Y1 - 2014/04/17/ PY - 2013/11/29/received PY - 2014/03/10/accepted PY - 2014/4/19/entrez PY - 2014/4/20/pubmed PY - 2014/10/31/medline SP - e2816 EP - e2816 JF - PLoS neglected tropical diseases JO - PLoS Negl Trop Dis VL - 8 IS - 4 N2 - 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. SN - 1935-2735 UR - https://www.unboundmedicine.com/medline/citation/24743472/Leishmania_HIV_co_infection:_clinical_presentation_and_outcomes_in_an_urban_area_in_Brazil_ L2 - https://dx.plos.org/10.1371/journal.pntd.0002816 DB - PRIME DP - Unbound Medicine ER -