Visceral leishmaniasis co-infection in people living with HIV/AIDS

Abstract

Visceral leishmaniasis (VL) is a worldwide disseminated infection transmitted by the bite of infected female sand flies. It is caused by a protozoan Leishmania donovani (LD). About 350 million people are at risk and 12 million people are affected worldwide. Leishmania and human immunodeficiency virus (HIV) co-infection occurs across the world, the situation being particularly alarming in southern Europe, where 50–75% of adult cases of VL are HIV positive.1 It is estimated that 500,000 new cases of VL occur annually. About 90% of these are in five countries, namely Bangladesh, Brazil, India, Nepal, and the Sudan.2 India has the largest number of VL cases, accounting for 40–50% of world disease burden3 and the second-largest HIV-infected population, accounting for approximately 10% of the global disease burden.4 The possible overlap in the distribution of VL and HIV in countries where both infections are highly endemic, such as India, may have grave consequences. VL has joined the list of AIDS-related opportunistic infections in endemic areas. Recently, HIV-VL co-infection has increased in prevalence, though tuberculosis is the commonest opportunistic infection in HIV.5 The triad of HIV, tuberculosis, and VL has been reported.6 A chronic, relapsing course is seen in co-infected patients, VL associated with HIV. These are the first two of the VL cases in people living with HIV/AIDS (PLHA) to be reported from the Armed Forces.7