Abstract
BackgroundThe urbanization of visceral leishmaniasis (VL) and the concurrent movement of the HIV infection to rural areas in Brazil are possible mechanisms associated with an increased number of Leishmania/HIV coinfected people. This study aimed to describe the clinical and epidemiological profile of VL/HIV coinfected patients and compare this profile to non-coinfected VL patients.MethodsCases of VL/HIV coinfection were obtained through a probabilistic record linkage of databases of VL and AIDS cases from the Brazilian Ministry of Health.ResultsWe retrieved 760 cases of VL/HIV coinfection, most prevalent in adult males, with incidence ranging from 0.01 to 0.07 cases, per 100.000 population, in 2001 and 2010, respectively. Case-fatality rates were 27.3% in 2001 and 23.2% in 2010. Weakness, weight loss, cough, other associated infections and haemorrhagic phenomena were more commonly found among coinfected patients, which had a fatality rate three times higher as compared to the non-coinfected group. The relapse proportion was two times greater among coinfected (6.3%) than non-coinfected (3.1%).ConclusionsThe results found herein contribute to the increase of knowledge of the epidemiological situation of VL/HIV coinfection in Brazil and reinforce the necessity of implementing specific strategies to improve early case detection and efficacious and less toxic treatment in order to achieve lower case-fatality rates.
Highlights
Visceral leishmaniasis (VL) is an anthropozoonosis associated to infection by different protozoa species of the genus Leishmania, primarily transmitted by the bite of infected phlebotomine sandflies
The urbanization of visceral leishmaniasis (VL) and the concurrent movement of the human immunodeficiency virus (HIV) infection to rural areas in Brazil are possible mechanisms associated with an increased number of Leishmania/HIV coinfected people
The results found contribute to the increase of knowledge of the epidemiological situation of VL/HIV coinfection in Brazil and reinforce the necessity of implementing specific strategies to improve early case detection and efficacious and less toxic treatment in order to achieve lower case-fatality rates
Summary
Visceral leishmaniasis (VL) is an anthropozoonosis associated to infection by different protozoa species of the genus Leishmania, primarily transmitted by the bite of infected phlebotomine sandflies. In Brazil, the disease is caused by Leishmania infantum, transmitted by vectors of the genus Lutzomyia [1, 2], with an estimated annual incidence of 4,200 to 6,300 cases and a case-fatality rate of 7% [3, 4]. Estimates indicate that 1/3 of the persons with HIV infection live in risk areas for leishmaniasis transmission. This geographic overlap results in an increasing number of HIV-Leishmania coinfected cases which has been reported in 35 countries [5, 6]. The urbanization of visceral leishmaniasis (VL) and the concurrent movement of the HIV infection to rural areas in Brazil are possible mechanisms associated with an increased number of Leishmania/HIV coinfected people. This study aimed to describe the clinical and epidemiological profile of VL/HIV coinfected patients and compare this profile to non-coinfected VL patients
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