Visceral Lieshmaniasis and HIV co-infection in patients admitted to Gondar University Hospital, Northwest Ethiopia

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Worldwide after malaria and sleeping sickness leishmaniases are the third most important vector borne diseases. Visceral leishmaniasis (kala-azar) is a disseminated protozoan infection caused by L. donovani L. infantum or L. arachibaldi and transmitted by the female phlebotomine sand fly bite. Coinciding with HIV infection the number of visceral leishmaniasis cases in Ethiopia has increased in the last decade. The objective was to assess the clinical and laboratory manifestations and factors associated with mortality and morbidity of visceral leishmaniasis with or without HIV co-infection. A hospital-based case series study of visceral leishmaniasis assessing clinical manifestations laboratory data treatment outcomes and HIV sero-status was conducted in Gondar University Teaching Hospital over a period of five years and seven months (from January 1999 to July 2004). A total of 221 kala-azar patients participated in the study. Out of 212 visceral leishmaniasis cases tested for HIV 87(41.0%) were HIV co-infected. Age > 20 years was independently associated with HIV co-infection. Out of 213 kala-azar patients treated with sodium stibogluconate (SSG) 52 died resulting in a case fatality rate of 24.4%. The case fatality rates among HIV positive and HIV negative kala-azar cases were 39.3% and 13.0% respectively. Using logistic regression HIV infection body mass index (BMI) of 15 and below bleeding tendency and age > 20 years were identified as independent variables predicting death. HIV co-infection and the case fatality rates are very high among patients with Visceral leishmaniasis. We recommend further study and improved care for HIV co-infected visceral leishmaniasis cases. (authors)