Abstract
The maintenance of chronic immune activation due to leishmaniasis or even due to microbial translocation is associated with immunosenescence and may contribute to frequent relapses. Our aim was to investigate whether patients with HIV-associated visceral leishmaniasis (VL/HIV) who experience a single episode of VL have different immunological behaviors in comparison to those who experience frequent relapses. VL/HIV patients were allocated to non-relapsing (NR, n = 6) and relapsing (R, n = 11) groups and were followed from the active phase of VL up to 12 months post-treatment (mpt). The patients were receiving highly active antiretroviral therapy (HAART) and secondary prophylaxis after VL therapy. During active VL, the two groups were similar in all immunological parameters, including the parasite load. At 6 and 12 mpt, the NR group showed a significant gain of CD4+ T cells, a reduction of lymphocyte activation, and lower soluble CD14 and anti-Leishmania IgG3 levels compared to the R group. The viral load remained low, without correlation with the activation. The two groups showed elevated but similar percentages of senescent T cells. These findings suggest a decreased ability of the R group to downmodulate immune activation compared to the NR group. Such functional impairment of the effector response may be a useful indicator for predicting clinical prognosis and recommending starting or stopping secondary prophylaxis.
Highlights
The increasing frequency of HIV-associated visceral leishmaniasis (VL/HIV) has become a significant problem in East Africa, Brazil and India
Our aim was to investigate whether patients with HIV-associated visceral leishmaniasis (VL/HIV) who experience a single episode of VL have different immunological behaviors in comparison to those who experience frequent relapses
At 6 and 12 mpt, the NR group showed a significant gain of CD4+ T cells, a reduction of lymphocyte activation, and lower soluble CD14 and anti-Leishmania IgG3 levels compared to the R group
Summary
The increasing frequency of HIV-associated visceral leishmaniasis (VL/HIV) has become a significant problem in East Africa, Brazil and India. Brazil presents the highest number of coinfection cases in South America, with 8.5% of the HIV-infected individuals in the country being co-infected with VL in 2012 [1]. Both diseases profoundly impair the immune mechanisms involved in the control of infections, which makes the outcomes of VL/HIV very poor. There is in vitro evidence that antiretrovirals, and protease inhibitors (PIs), have an inhibitory effect on the evolutionary forms of Leishmania (L.) infantum [10,11] This finding indicates another factor that could contribute to the decline of new VL cases among HIV-infected people receiving HAART [10,11,12]
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