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There are contradictory data about whether highly active antiretroviral therapy (HAART) prevents visceral leishmaniasis (VL) relapses in human immunodeficiency virus type 1 (HIV-1)-infected patients. The aim of this study was to assess the frequency of VL relapses in individuals receiving HAART. Thirty-one patients who received HAART after developing VL were included in a retrospective cohort study. Ten of them received secondary chemoprophylaxis and the rest did not. Eight (38%) patients without secondary chemoprophylaxis showed a VL relapse. None of the seven subjects with VL relapses and 6 of 11 without recurrence (P = 0.038), in whom all scheduled data were available, showed an increase of more than 100 CD4+ cells/mm3 during the follow-up. Patients with relapse showed higher levels of HIV RNA viral load at their last visit (P = 0.047). The frequency of VL relapses in patients receiving HAART is high. Relapses of VL are observed only in individuals with uncontrolled HIV replication and/or poor immunologic responses.
Received April 9, 2003. Accepted for publication November 26, 2003.
Authors’ addresses: José A. Mira, Juan Macias, and Juan A. Pineda, Servicio de Medicina Interna, Hospital Universitario de Valme, Carretera de Cádiz s/n, 41014-Seville, Spain, Telephone: 34-95-501-5887, Fax: 34-95-501-5747, E-mails: PEPINESCARTI{at}ono.com, jmacias{at}cica.es, and japineda{at}nacom.es. Juan E. Corzo, Fernando Lozano de León, and Jesús Gómez-Mateos, Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme, Carretera de Cádiz s/n, 41014-Seville, Spain, Telephone: 34-95-501-5787, Fax: 34-95-501-5757, E-mails: jecorzo{at}nacom.es, flozano{at}nacom.es, and gmateos{at}nacom.es. Antonio Rivero, Julián Torre-Cisneros, and Rafael Jurado, Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Avda. Menéndez Pidal s/n, 14004-Córdoba, Spain, Telephone and Fax: 34-95-701-1636, E-mails: arivero{at}hrs.sas.junta-andalucia.es, jtorres{at}hrs.sas.junta-andalucia.es, and jurado{at}hrs.sas.junta-andalucia.es.
Reprint requests: Juan A. Pineda, Servicio de Medicina Interna, Hospital Universitario de Valme, Carretera de Cádiz s/n. 41014-Seville, Spain. Phone: 34-95-5015887. Fax: 34-95-5015747. E-mail: japineda{at}nacom.es.
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