Abstract
Visceral Leishmaniasis (VL) is an important protozoan opportunistic disease in HIV patients in endemic areas. East Africa is second to the Indian subcontinent in the global VL caseload and first in VL-HIV coinfection rate. Because of the alteration in the disease course, the diagnostic challenges, and the poor treatment responses, VL with HIV coinfection has become a very serious challenge in East Africa today. Field experience with the use of liposomal amphotericin B in combination with miltefosine, followed by secondary prophylaxis and antiretroviral drugs, looks promising. However, this needs to be confirmed through clinical trials. Better diagnostic and follow-up methods for relapse and prediction of relapse should also be looked for. Basic research to understand the immunological interaction of the two infections may ultimately help to improve the management of the coinfection.
Highlights
Visceral leishmaniasis (VL) is a vector-borne protozoan infection targeting the reticuloendothelial system [1]
While most post-kala-azar dermal leishmaniasis (PKDL) case reports from Sudan were in HIV-negative patients, a study in Ethiopia indicated that PKDL was more frequent among HIV patients, with an incidence of moderate–severe PKDL of 27.3% in HIV patients and 13.3% among non-HIV patients by the sixth month after VL treatment [23]
The DiaMed-ITLEISH (Bio-Rad Laboratories) showed satisfactory sensitivity (85%–90%) and specificity (90%– 99%) in immunocompetent patients in East Africa and performs significantly better than the Kalazar Detect (Inbios International) [25,26]
Summary
Visceral leishmaniasis (VL) is a vector-borne protozoan infection targeting the reticuloendothelial system [1]. The high HIV coinfection rate in northwest Ethiopia could be due to the massive population movement in the region [13]. In this area of cash-crop farming, there is a high labour demand, and 300,000 to 500,000 highlanders from urban and semiurban areas seasonally move in and out of the region. The HIV prevalence among primary VL cases in the other MSF treatment areas in the same period were as follows: South Sudan 61/2,426 (2.5%); Sudan 19/1,455 (1.3%); and Kenya 22/1,595 (1.4%). Systematic testing of VL patients for HIV in MSF programs in Sudan and South Sudan between 2009 and 2012 showed an HIV coinfection rate of 2%–2.5% (MSF, unpublished data). Less virulent parasites (nonhuman pathogenic trypanosomatids and etiologic agents of the cutaneous form of the disease) were isolated from VL cases in some HIV-coinfected cases in zoonotic transmission regions [5], there are no reports of such cases from this region to date
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
